SAPT:a synchrotron-based proton therapy facility in Shanghai

Because of its excellent dose distribution,proton therapy is becoming increasingly popular in the medical application of cancer treatment.A synchrotron-based proton therapy facility was designed and constructed in Shanghai.The synchrotron,beam delivery system,and other technical systems were commissioned and reached their expected performances.After a clinical trial of 47 patients was finished,the proton therapy facility obtained a registration certificate from the National Medical Products Administration.The characteristics of the accelerator and treatment systems are described in this article.

输尿管镜钬激光碎石术后早期并发症的Clavien-Dindo分级及影响因素分析

目的应用Clavien-Dindo分级系统(CDCS)对经尿道输尿管镜钬激光碎石术(URL)治疗输尿管结石所致的早期并发症按严重程度进行分级,并探讨术后早期并发症的影响因素。方法回顾性分析2013年1月—2019年9月宜昌市第一人民医院泌尿外科行URL治疗的1142例输尿管结石患者的临床资料,按术后是否出现并发症分为并发症组144例和无并发症组998例。应用CDCS对术后早期并发症进行统计分析,采用Logistic回归模型分析术后早期并发症发生的影响因素,建立URL术后早期并发症预测模型。结果术后出现并发症144例,发生率12.6%。CDCS分析结果显示,Ⅰ级并发症76例(52.8%)、Ⅱ级37例(25.7%)、Ⅲa级15例(10.4%)、Ⅲb级9例(6.3%)、Ⅳa级1例(0.7%)、Ⅳb级6例(4.2%)、Ⅴ级并发症0例(0.0%)。单因素分析结果显示,结石负荷、结石位置、手术时间、合并糖尿病、术前发热、术前降钙素原、术前尿培养、重度肾积水、合并输尿管狭窄、病程、术者熟练程度是URL术后发生早期并发症的影响因素(P<0.05)。多因素Logistic回归分析显示,结石负荷≥45 mm;[OR=1.039(95%CI:1.010,1.070)]、结石位于输尿管上段[OR=1.734(95%CI:1.211,2.482]、手术时间≥60 min[OR=1.032(95%CI:1.006,1.058)]、合并糖尿病[OR=1.832(95%CI:1.040,3.227)]、术前尿培养阳性[OR=3.163(95%CI:1.195,8.373)]、合并输尿管狭窄[OR=2.010(95%CI:1.102,3.669)]和术者为低年资医师[OR=2.213(95%CI:1.414,3.463)]是URL术后早期并发症发生的独立影响因素(P<0.05)。根据这7个因素建立的URL术后早期并发症预测模型的受试者工作特征曲线下面积为0.791(95%CI:0.756,0.826),敏感性为77.1%(95%CI:0.696,0.832),特异性为65.1%(95%CI:0.621,0.680)。结论URL术后早期并发症分级主要为Clavien-Dindo分级Ⅰ级、Ⅱ级。结石负荷≥45 mm^(2)、结石位于输尿管上段、手术时间≥60 min、术前尿培养阳性、合并糖尿病、合并输尿管狭窄和低年资医师实施手术可能会增加URL术后早期并发症。

Combination patterns of precipitation and its concentration degree determining the risk of dengue outbreaks in China

The amount and distribution of precipitation can determine dengue risk by affecting mosquito breeding;however,previous studies failed to incorporate this bivariate characteristic to examine dengue fever transmission.In the present research,nationwide data on daily dengue cases in China between January 2005 and December 2020 were obtained,and the top 12 cities accounting for 78%of total cases were selected for analysis.Precipitation patterns were quantified by weekly precipitation and precipitation concentration degree(PCD).On the basis of the combinations of both parameters,the exposure-response relationships of precipitation with dengue risk were established using generalised additive models,and the high-dengue-risk thresholds of precipitation patterns were further identified.Dengue burden was assessed by calculating attributable dengue cases.For the same amount of precipitation,the dispersed precipitation in the pre-summer rainy season leads to a higher dengue risk in autumn.The weekly precipitation of 100-150 mm and PCD of 0.2-0.4 constitute the highest risk scenario,and the average frequency of precipitation associated with dengue risk in 2013-2020 is 1.6 times higher than that in 2005-2012.A total of 3093 attributable dengue cases are identified.From 2005 to 2020,the amount of dispersed precipitation increased in southern and southwestern China and posed high dengue risks in central China.This study has improved the understanding of the health impacts of irregular rainfall under climate change.Our approach to identifying thresholds provides information for early warning systems and helps reduce the risk of dengue transmission in the long run.