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BackgroundAcute hematologic toxicity (HT) is a common complication during radiotherapy of cervical cancer which may lead to treatment delay or interruption. Despite the use of intensity-modulated radiation therapy (IMRT) with the pelvic bone marrow (PBM) sparing, some patients still suffer from acute HT. We aimed to identify predictors associated with HT and develop a nomogram for predicting grade 2 or higher (G2+) acute HT in cervical cancer following the PBM sparing strategy.MethodsThis study retrospectively analyzed 125 patients with cervical cancer who underwent IMRT with the PBM sparing strategy at our institution. Univariate and multivariate logistic regression, best subset regression, and least absolute shrinkage and selection operator (LASSO) regression, respectively, were used for predictor screening, and Akaike information criterion (AIC) was used to determine the best model for developing the nomogram. Finally, we quantified the risk of G2+ acute HT based on this model to establish a risk stratification.ResultsThe independent predictors used to develop the nomogram were histological grade, pre-radiotherapy chemotherapy, pre-radiotherapy HT, and radiotherapy [IMRT alone vs. concurrent chemoradiotherapy (CCRT)] which were determined by the univariate and multivariate logistic regression with the minimum AIC of 125.49. Meanwhile, the heat map showed that there is no multicollinearity among the predictors. The nomogram was well-calibrated to reality, with a Brier score of 0.15. The AUC value was 0.82, and the median Brier score and AUC in 1000 five-fold cross-validation were 0.16 and 0.80, respectively. The web version developed together was very easy to use. The risk stratification indicated that high-risk patients (risk point > 195.67) were more likely to develop G2+ acute HT [odds ratio (OR) = 2.17, 95% confidence interval (CI): 1.30–3.05].ConclusionThis nomogram well-predicted the risk of G2+ acute HT during IMRT in cervical cancer after the PBM sparing strategy, and the constructed risk stratification could assist physicians in screening high-risk patients and provide a useful reference for future prevention and treatment strategies for acute HT.

The Qinghai–Tibet Plateau is a region sensitive to climate change with significant changes in topography, and the increase in extreme precipitation in the region easily leads to landslides and debris flows. To mitigate the effects of climate change, the Chinese government has pledged to an emission reduction target that achieves a “carbon peak’” in 2030 and being “carbon neutral” in 2060 at a huge cost. In order to explore the quantitative flood risk at the county level in Qinghai province (the core province of the Qinghai–Tibet Plateau) and the contribution of emission reduction efforts to risk mitigation, this article constructs a loss rate curve based on the data of more than 1,000 single flood disasters from 2009 to 2019 through government cooperation and the data of observed cumulative precipitation. Combined with the latest CMIP6 climate model data, the temporal and spatial variation characteristics of the flood loss ratio in Qinghai province from 2020 to 2060 are quantitatively characterized. The results show the following: 1) the curve of the flood loss rate in Qinghai province from 2020 to 2060 may present a trend of “rising in the early stage, stable in the middle stage, and declining in the late stage” under low (SSP126) and medium (SSP245) emission scenarios and presents a trend of rising fluctuation under the high-emission (SSP585) scenario. The flood loss ratio under SSP585 is 10 times higher than that under SSP126; 2) the flood risk of 44 counties from 2020 to 2060 in Qinghai province may be concentrated in the southeast region, with Jiuzhi county, Banma county, Nangqian county, Gande county, and Dari county being the most prominent; (3) compared with SSP585, the Qinghai province in SSP126 may cumulatively avoid about 24 billion CNY in economic losses from 2020 to 2060 and avoid nearly 600 million CNY in losses per year, which is equivalent to 93% of Qinghai province’s special funds for ecological and environmental protection in 2019. The research aims to provide theoretical and data support for flood disaster risk prevention and management in China’s high-altitude areas and to promote the initiative of emission reduction in China and even the world.

Background: Cryptorchidism is the most common congenital anomaly in pediatric urology. Although early surgery on cryptorchid boys is recommended by pediatric urologists worldwide, the actual age at orchidopexy is often older than the recommended age. Our medical center has started performing ambulatory orchidopexy since March 2016 at the ambulatory surgery center. We aimed to investigate whether ambulatory orchidopexy can improve the timely repair rate.Methods: A retrospective analysis was conducted from 2012 to 2019 at our medical center. Ambulatory orchidopexy was started at our medical center on March 24, 2016. Boys born on or after September 24, 2015 were classified into the “with ambulatory medical resource” group, and boys born before September 24, 2014, were classified into the “without ambulatory medical resource” group. The timely repair rates were calculated and compared.Results: A total of 4,972 cryptorchidism cases were included in the final study. Approximately 33.0% of cryptorchid boys received timely surgery (orchidopexy by the age of 18 months), and only 6.8% of all cryptorchid boys underwent surgery before the age of 1 year. After the performance of ambulatory orchidopexy, the timely repair rate increased from 25.7 to 37.0% (P < 0.001), and the percentage of patients receiving surgery before the age of 1 year increased significantly from 3.5 to 8.6% (P < 0.001). The proportion of timely repair in patients with ambulatory medical resources was significantly higher than that in patients without ambulatory medical resources (15.6% vs. 58.2%, P < 0.001). Significant changes in the rate of surgery before 12 months of age were also found between the two groups (2.4% vs. 14.8%, P < 0.001).Conclusions: After the performance of ambulatory orchidopexy in our medical center, the rates of both timely repair and receiving surgery before the age of 1 year increased significantly. Ambulatory orchidopexy is a potential solution to improve the rate of timely repair in cryptorchid boys, and it is worthy of promotion in developing countries and regions.