Objective To analyze the anatomic changes and dosimetric variations of patients with head-and-neck cancer during intensity-modulated radiotherapy and to assess the necessity of re-planning the treatment course.Methods Twenty-one nasopharyngeal carcinoma patients were selected to receive the second CT scan in the course of intensity-modulated radiotherapy,targets and organs at risk were re-contoured on the new CT images with the help of deformable registration software.Actual dose distribution delivered by the original treatment plan was calculated on the second CT image,and then the volume and doses of targets and organs at risk were compared between the planning CT and second CT.Results The volume of patient's head-and-neck outlines and GTVnd decreased significantly,the volume of cord and brainstem didn't change much,while the volume of left and right parotids decreased significantly by (24.23 ± 12.15)％ and (25.82± 10.46)％,respectively.The parameters D95％ and Dmean of PGTVnx kept stable,but the parameters D1cc of spinal cord PRV and brainstem PRV increased by (8.12± 10.32)％ and (14.60±18.85)％ respectively.The mean dose of the left and right parotids increased significantly by (27.43±17.67)％ and (26.76±12.46)％,respectively.Conclusion The anatomical changes of patients undergoing intensity-modulated radiotherapy will cause significant dosimetric variations of the cord,brainstem and parotids,so it's meaningful and necessary to re-design the treatment plan in the course of radiotherapy.Repeat CT imaging and replanning during the course of IMRT is essential to ensure adequate doses to target volumes and safe doses to normal tissue.

Objective To analyze the impact of dose calculation resolution on Gamma pass rate for planar dose distribution verification of intensity-modulated radiotherapy (IMRT),and to find out the appropriate calculation resolution value with specific applied criteria.Methods 25 IMRT plans were selected for the planar dose verification.The Gamma pass rates with 3 mm/3％,2 mm/2％ and 1 mm/1％ criteria were compared and analyzed.The planar dose distributions were calculatedand exported from TPS with different resolutions of 0.5,1,2,3,4 and 5 mm.The pass rates of Gamma analysis between the computed dose distributions with different resolutions and the dose distributions measured by Mapcheck device were compared and analyzed.Results The average Gamma pass rates of all the 225 fields decreased with the increment of calculation resolution.When the pass rates of Gamma analysis were calculated using 3 mm/3％ criteria,the gamma pass rate with 1 mm and 0.5 mm calculation resolution were (98.3±1.3)％ and (98.3±1.2)％,respectively.The results were almost the same and the difference wasn't statistically significant (P＞0.05).The gamma pass rates with greater than or equal to3 mm calculation resolution were significantly less than the pass rate with 0.5 mm calculation resolution (P＜0.05).When the pass rates of Gamma analysis were calculated using 2 mm/2％ criteria,all the pass rates with greater than 0.5 mm calculation resolution were significantly less than the pass rate with 0.5 mm calculation resolution (P＜0.05).Conclusions The Gamma pass rates of planar dose verification reduce significantly with the increment of calculation resolution.In order to reduce the effect of calculation resolution on Gamma pass rate,the lower calculation resolution should be used.When using the 3 mm/3％ criteria for the Gamma analysis,1 mm calculation resolution is recommended.When using the 2 mn/2％ criteria for the Gamma analysis,0.5 mm calculation resolution is recommended.The appropriate calculation resolution will ensure the reliability of planar dose verification.

Objective To compare the differences in gut microbiota between cirrhosis patients receiving transjugular intrahepatic portosystemic shunt(TIPS)and those not,and explore the relationship between TIPS surgery and gut microbiota in order to provide new ideas for improving the prognosis of cirrhosis patients after TIPS surgery based on gut microbiota.Methods Those who had received TIPS surgery previously were assigned into the operation group,and those without the surgery served as the control group.Their stool samples were collected for 16S rRNA sequencing,and the correlation between gut microbiota and clinical indicators was analyzed.Results There were no significant differences in gender,age,body mass index(BMI),etiology and other baseline data between the 2 groups(P＞0.05),but obvious differences were observed in clinical serological indicators between them,including INR,APTT,RBC and PT counts,and HGB,ALP,ALB,total bilirubin(TBIL),and URE levels(P＜0.05).No statistical difference in alpha diversity was observed between the operation group and the control group(P＞0.05),but beta diversity was obviously different(P＜0.01),among which Bacteroides was increased in the operation group(P＜0.01)and Bifidobacterium was increased in the control group(P＜0.05).The function prediction analysis of gut microbiota showed that the metabolism of D-glutamine and D-glutamate(P＜0.05)and biosynthesis with secondary bile acids(P＜0.05)were up-regulated in the operation group compared with the control group.Correlation analysis between clinical indicators and flora indicated that TBIL and direct bilirubin(DBIL)were significantly correlated with the metabolic pathways of Bacteroides and Secondary bile acids biosynthesis.Conclusion Characteristic changes in gut microbiota are found in cirrhosis patients with and without TIPS surgery.Bacteroides may be involved in the regulation of metabolism of bile acids and thus increase bilirubin level.

Objective To verify the feasibility and effectiveness of the beam hardening correction method based on Monte Carlo simulation and energy spectrum partitioning for X-ray image.Methods A beam hardening correction method based on Monte Carlo simulation and energy spectrum partitioning for X-ray image was presented.The Monte Carlo simulation results of multi-energy X-ray spectra and single-energy X-ray energy deposition were saved as a hardening correction database.The rapid calculation of the multi-energy projection data was achieved by adapting the hardening correction database based on the step size of energy spectrum partitioning and specific energy spectrum distribution of the rays.Subsequently,a polynomial fitting was performed on the multi-energy projection data and the penetration lengths of the rays through the detected object,thus realizing the fitting of hardening correction parameters for X-ray image.Results The HU value curve of the X-ray image after beam hardening correction by the proposed method was flatter.Under the condition of a tube voltage of 120 kV and a step size of 10 keV,the uniformity of the X-ray image was improved by 29.40%.Compared with the traditional Monte Carlo beam hardening correction method,the proposed method effectively improved the efficiency of the beam hardening correction parameter fitting.Conclusion The proposed beam hardening correction method based on Monte Carlo simulation and energy spectrum partitioning for X-ray image is feasible and effective.

Objective:To explore the perceived differences of medical staff in the hierarchical diagnosis and treatment effectiveness of telemedicine from the perspective of supply and demand, as well as the moderating effects in their respective regions, in order to provide reference for the integrated development of telemedicine services and hierarchical diagnosis and treatment.Methods:From June to September 2023, a survey was conducted on the current status and effectiveness of telemedicine services among medical staff from 245 hospitals in 27 provinces. Using non participants as the reference group, an ordered probit model was used to explore the differences in perception of the hierarchical diagnosis and treatment effectiveness of telemedicine services among medical staff who only served as suppliers, only as demanders, and simultaneously as suppliers/demanders; Using the region as a moderating variable, explore the perceived differences among medical staff in different regions.Results:A total of 997 valid questionnaires were obtained. Medical staff who only served as the demanders ( β=0.197, P<0.05) and simultaneously served as suppliers/demanders ( β=0.189, P<0.01) thought that the implementation of telemedicine could significantly improve the effectiveness of hierarchical diagnosis and treatment, while those who only served as the suppliers thought that the implementation of telemedicine did not significantly improve the effectiveness of hierarchical diagnosis and treatment ( β=-0.028, P>0.05). With the eastern region, medical staff in the central and western regions believed that providing telemedicine services simultaneously as suppliers/demanders could better improve the effectiveness of hierarchical diagnosis and treatment ( β=-0.324, P<0.05). Conclusions:The role and location of medical staff involved in telemedicine services could lead to differences in their perception of hierarchical diagnosis and treatment effectiveness.

Healthy Sanming is a new stage, a new goal and a new station of Sanming′s reform of medical and health system. Based on the rainbow model, the author summarized and analyzed the theoretical logic, content framework and practical effectiveness of the health protection system in new era, summarized the advanced experience and practices in the construction of Healthy Sanming, and systematically interpreted the Sanming practice in Healthy China. Vertically, the macro-level of institutional integration constructed a regional healthcare mechanism to improve the protection system, the meso-level of organizational integration promoted the four-tier referral mode to build a protection network, the micro-level of the professional integration carried out in-depth medical and preventive synergy and fusion to protect the key populations, and the service integration provided life-cycle health services to consolidate the health coverage. Horizontally, the instrumental level drived health performance through the innovation of the health insurance fund and payment method, and the value level standardized and balanced the layout of resources by enhancing the primary medical service capacity. Constructing the health protection system in new era is an important initiative for the construction of healthy Sanming, public hospitals have shifted their focus from treating diseases to treating diseases and health management, the service system has shifted from the program system of health care and health to the synergy and integration of medical and preventive care, and medical insurance payment has shifted from regulating the behavior of doctors′ practice to encouraging the development of health promotion. These health transformations have resulted in a series of experiences that can inform the articulation of the reform of medical and health system with the construction of Healthy China.

Objective To evaluate the performance of progressive optimization algorithm-based Auto-Planning module in automated volumetric-modulated arc therapy(VMAT)planning for nasopharyngeal carcinoma. Methods Thirteen treated VMAT plans of nasopharyngeal carcinoma were re-planed with Auto-Planning module. Only one cycle of automated optimization of the Auto-Planning module was performed for each plan without any manual intervention. The dosimetric parameters of the automated treatment plans were compared with those of the manual plans. Paired t-test was used for statistical analysis. The time required for automated planning using the Auto-Planning module was also measured. Results All plans generated with the Auto-Planning module met the routine dosimetric requirements and were acceptable for clinical use. The homogeneity index of targets was superior in the automated plans than in manual plans(P= 0.000).In addition,the automated plans had significantly improved protection for some organs at risk than the manual plans. The mean dose to the left and right parotids were reduced by 7.75 Gy(P=0.000)and 5.79 Gy(P=0.000)in the automated plans,respectively. Furthermore,the V60(0.58% vs. 3.12%,P=0.000)and Dmean(34.11 Gy vs. 40.78 Gy,P= 0.000)of the mandible were also significantly lower with Auto-Planning than with manual planning. Conclusions Auto-Planning module can improve the overall quality and consistency of treatment plans,and reduce the workload and time of treatment planning,resulting in substantially enhanced treatment planning efficiency.

As a ligand-dependent transcription factor,retinoid-associated orphan receptor γt(RORyt)that controls T helper(Th)17 cell differentiation and interleukin(IL)-17 expression plays a critical role in the pro-gression of several inflammatory and autoimmune conditions.An emerging novel approach to the therapy of these diseases thus involves controlling the transcriptional capacity of RORyt to decrease Th17 cell development and IL-17 production.Several RORyt inhibitors including both antagonists and inverse agonists have been discovered to regulate the transcriptional activity of RORyt by binding to orthosteric-or allosteric-binding sites in the ligand-binding domain.Some of small-molecule inhibitors have entered clinical evaluations.Therefore,in current review,the role of RORyt in Th17 regulation and Th17-related inflammatory and autoimmune diseases was highlighted.Notably,the recently developed RORyt inhibitors were summarized,with an emphasis on their optimization from lead compounds,ef-ficacy,toxicity,mechanisms of action,and clinical trials.The limitations of current development in this area were also discussed to facilitate future research.

Abstract OBJECTIVE To develop a vancomycin individualized dosing-assisted decision platform suitable for practical clinical application scenarios and provide individualized dosing recommendations for the rational use of vancomycin. METHODS Based on the vancomycin population pharmacokinetic model that had been constructed and verified to be feasible, the vancomycin individualized assisted decision-making platform was developed by using Idea2019, JDK1.8, ETL and other software tools. The platform development had gone through three main stages, included ①requirement analysis; ②design stage; ③software testing and optimization. RESULTS The vancomycin individualized assisted decision-making platform, which was successfully developed and applied, had the advantages of simple page, perfect function and convenient operation, and was divided into four main modules according to functions, namely retrieval module, information module, concentration prediction module and reporting module. The platform could connect to the hospital intranet platform to automatically obtain patient information, medication information and blood concentration test results, and calculate individual pharmacokinetic parameters for subsequent concentration prediction based on the embedded population pharmacokinetic model, combined with individual parameters. The concentration prediction module incorporated the Bayesian feedback method with patient medication information, drug concentration measurement results and relevant covariate parameter values, took the guideline-recommended trough concentration and AUC range as the target value, calculated the individualized drug administration scheme that met the target concentration range, and set up custom simulation functions considering the actual clinical application scenarios, which was of more popularization and application value. CONCLUSION Based on the vancomycin population pharmacokinetic model that has been successfully constructed in the previous stage, with the assistance of Idea2019, JDK1.8, ETL and other software tools, a vancomycin individualized dosing-assisted decision platform has successfully constructed, which can more efficiently and conveniently assist monitoring pharmacists to provide individualized dosing advice for clinical use of vancomycin.

To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization, led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles, research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles, Professional Committee on Extracellular Vesicle Research and Application, Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles. Based on the collation of relevant literature, we have adopted the Delphi method, the consensus meeting method combined with the nominal group method to form a discussion draft of "Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles (2023)". The first draft was discussed in online and offline meetings on October 12, 14, November 2, 2022 and April and May 2023 on the current status of research, nomenclature, isolation methods, quality standards and research applications of extracellular vesicles of Chinese herbal medicines, and 13 consensus opinions were finally formed. At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles, held on May 26, 2023, Kewei Zhao, convenor of the consensus, presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles. The consensus highlights the characteristics and advantages of Chinese medicine, inherits the essence, and keeps the righteousness and innovation, aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad, decode the mystery behind Chinese herbal vesicles together, establish a safe, effective and controllable accurate Chinese herbal vesicle prevention and treatment system, and build a bridge for Chinese medicine to the world.