The real-time Delphi method represents a refinement of the classical Delphi technique, designed to overcome limitations such as prolonged study duration and delayed feedback during consensus development. This article, building upon the classical Delphi foundation, systematically elaborates on the application process, advantages, and limitations of the real-time Delphi method. It further presents currently available websites or software capable of facilitating real-time Delphi exercises and offers considerations and recommendations for its application in guideline development, aiming to serve as a reference for relevant researchers.

ObjectiveTo study the relationship between qi stagnation constitution and suboptimal health status (SHS) or lifestyle.MethodsFrom 2012 to 2013, we conducted a cross-sectional survey of 24 159 Chinese individuals aged 12–80 years. The qi stagnation constitution was assessed using the Constitution in Chinese Medicine Questionnaire. Health status was evaluated through medical records and the Subhealth Measurement Scale V1.0 (SHMS V1.0). Health-promoting lifestyles were measured using the Health-Promoting Lifestyle Profile II (HPLP-II).ResultsOf the 24 159 participants, 16.1% and 15.2% were classified as “always” and “sometimes” having the qi stagnation constitution, respectively. Those classified as “rarely” having the qi stagnation constitution scored higher on both the HPLP-II and SHMS V1.0. The participants classified as “always” having the qi stagnation constitution showed a significant association with SHS or disease compared to other imbalanced constitutions. Those in the “always” category were approximately 21 times more likely to be classified as having SHS (odds ratio [OR]: 21.17, 95% confidence interval [CI]: 15.74–28.45), whereas those in the “sometimes” category were approximately six times more likely (OR: 5.89, 95% CI: 5.04–6.90). Accordingly, the qi stagnation constitution score was significantly associated with the diagnosis of SHS, with an area under the curve of 0.77 (P .001). A score of 18.75 yielded the highest Youden Index (0.407), with a sensitivity of 60.5% and a specificity of 80.3%. Significant associations were observed between health-promoting lifestyles and qi stagnation constitution severity in an ordinal regression analysis (P .001). Protective factors included stress management (OR: 1.59), self-actualization (OR: 1.57), and exercise (OR: 1.36). In contrast, poorer interpersonal relationships (OR: 0.79), greater health responsibilities (OR: 0.86), and poorer nutrition (OR: 0.91) were associated with increased severity.ConclusionModulating the qi stagnation constitution through lifestyle interventions may help prevent the progression of SHS to disease, which aligns with core preventive principles in traditional Chinese medicine.

Gei Herba is a traditional folk herbal medicine with a variety of functions such as replenishing Qi and invigorating spleen， tonifying blood and nourishing Yin， moistening lung and resolving phlegm， activating blood and alleviating edema， moving Qi， and activating blood. The reports about the pharmacological effects of this herbal medicine have been increasing in recent years. By reviewing the ancient and modern literature about Gei Herba， we systematically organized the name， original plants， nature， taste， and functions of this herbal medicine， and summarized the modern pharmacological studies and clinical applications of Gei Herba in cardiovascular and cerebrovascular diseases. Gei Herba was first recorded in the name of "Dijiao" in the Geng Xin Yu Ce（《庚辛玉册》） written in the Ming Dynasty. It is derived from Geum japonicum var. chinense （Rosaceae） and sometimes confused with Adina rubella （Rubiaceae）. This medicine had numerous synonyms in the local materia medica books. Gei Herba is widely distributed and harvested in summer and autumn， with the dried whole grass used as medicine. The historical records of the nature， taste， meridian tropism， main functions， and indications of Gei Herba are not consistent. It is generally believed that Gei Herba is pungent， bitter， sweet， cool， and has tropism to the liver， spleen， and lung meridians. Based on the effects of tonifying Qi， activating blood， and nourishing Yin， modern pharmacological studies have reported that the extracts of Gei Herba and the tannin phenolic acid compounds and triterpenoids isolated from Gei Herba have therapeutic effects on cardiovascular and cerebrovascular diseases such as hypertension， myocardial ischemia， cerebral ischemia， and vascular dementia. This study provides a reference for discovering the clinical advantages of Gei Herba and developing new drugs.

Objective:To introduce the method and result of the modeling and preliminary dose verification of the treatment planning system used in the first domestic proton therapy device of China (Raystation 10B, a system of scientific research version with no available registration certificate) and to verify the modeling accuracy using dose verification result.Methods:The modeling method for a treatment planning system (TPS) mainly included the data acquisition and modeling of integrated depth dose (IDD) curves, the data acquisition and modeling of beam spot profiles in air, and the calibration and modeling of absolute dose by scanning a 10 cm ×10 cm square field with a spot spacing of 2.5 mm. By measuring the dose distributions in three cases with different complexity levels and comparing them with the dose distributions calculated using the TPS, this study verified and analyzed the modeling accuracy and proposed the requirements for beam parameters and the commissioning suggestions of the proton device.Results:The peak values of the IDD curves of low-energy regions fitted using the TPS model were less than the measured values, while those of medium- and high-energy regions fitted using the TPS model approximated the measured values. The range in all energy regions fitted accurately. For the three cases with different complexity levels, the deviation between the average dose calculated by the TPS and that measured was within ±5% (national standard for type tests of medical devices). Moreover, the DTA of high-dose-gradient areas was less than 3 mm.Conclusions:The modeling accuracy of the TPS generally meets the verification requirements. However, due to the low resolution of IDDs obtained by Monte Carlo simulation in the TPS model and the sharp Bragg peaks of low-energy regions, the IDD modeling accuracy of low-energy regions is insufficient.

Objective:In Shanghai Advanced Proton Therapy Facility (SAPT) of Ruijin Hospital Proton Therapy Center, the calculation accuracy of the commercial proton treatment planning system RayStation (V10), especially the accuracy of the proton range calculation, was measured and verified, aiming to provide reference for the clinical application of the treatment planning system.Methods:A head phantom was used to verify the calculation accuracy of RayStation. The phantom CT was imported into treatment planning system (TPS). The phantom was followed closely by a water tank with a one-liter cubic target. A single field verification plan with the prescribed dose of 200 cGy (relative biological effectiveness) was designed and implemented. Then, the measured distribution results were compared with the calculation results.Results:When the verification plan of the phantom was designed with the default settings of RayStation, the measured longitudinal dose distribution was approximately 4 mm deeper than that of TPS, indicating that RayStation overestimated the water equivalent thickness (WET) of the tissue substitute materials in the phantom. To study the range error, the actual beam was used to measure the WET of the soft tissue substitute material. The default setting of RayStation was fine-tuned according to the measured results. It was found that the error between the measured SOBP and TPS calculations was reduced to only 2 mm.Conclusions:Using the default setting of RayStation to calculate the stopping power of the phantom may cause a large range error. A method that combines tissue segmentation with the measured WET of the tissue substitute material is proposed to improve the range calculation accuracy of the TPS. The results show that the proposed method can improve the dose and range accuracy of the commercial TPS including RayStation for tissue substitute materials.

Objective:To propose a new robust optimization method, known as modified worst case method, was proposed, which can enable users to control the trade-off between nominal plan quality and plan robustness.Methods:In each iteration of the plan optimization process, the dose value of each voxel in nine scenarios, which corresponded to a nominal scenario and eight perturbed scenarios with range or set-up uncertainties, were calculated and the maximum of deviations of each scenario voxel dose from that of the nominal scenario was included as an additive robust optimization term in the objective function. A weighting factor p robust was used to this robust optimization term to balance the nominal plan quality and plan robustness. Results:The robust optimization methods were implemented and compared in an in-house developed robust optimization module. When p robust=0.8, compared with conventional optimization, the ΔD 95% of CTV was reduced from 9.8 Gy to 7.6 Gy. When p robust was reduced from 1 to 0, ΔD 95% was increased from 7.0 Gy to 9.8 Gy, whereas the D 95% and D max of CTV, and the D 5% and D max of organs at risk (OAR) in the nominal scenario were reduced. Conclusions:The proposed modified worst case method can effectively improve the robustness of the plan to the range and set-up uncertainties. Besides, the weighting factor p robust in this method can be adopted to control the trade-off between nominal plan quality and plan robustness.