OBJECTIVE To comprehensively assess the rationality and safety of clinical application of ceftazidime-avibactam(CAZ/AVI)so as to provide bases for reasonable and safe application of the drugs.METHODS A total of 137 patients who were hospitalized in Tianjin First Central Hospital and were treated with CAZ/AVI from Jan.2023 to Jan.2024 were recruited as the research subjects.The relevant informations involving the baseline da-ta,infection sites,etiological tests,status of drug utilization and adverse reactions were investigated and statically analyzed.The rating form was designed based on relevant guideline consensus and package insert,and the rational-ity and safety of clinical application of days were evaluated.RESULTS Totally 137 valid cases were enrolled in the study,88(64.23％)of whom were male,and 49(35.77％)were female,with the mean age(52±21.89)years old and the average medication duration(12.2±6.45)days.Totally 79 case-times of drug administration were un-reasonable,involving 75 patients;unsuited indications,unreasonable treatment course,absence of special consul-tation and ward round records and no curative effect evaluation after drug administration for 48-72 hours were the major manifestations.The total effective rate of CAZ/AVI treatment was 87.62％,5 patients had CAZ/AVI-associated adverse reactions,with the incidence of adverse reactions 3.65％.CONCLUSION It is necessary for the hospital to further standardize and optimize the clinical utilization of CAZ/AVI,strictly conform to the medica-tion indications,and strengthen the medication surveillance so as to raise the rationality and safety of medication.

Objective To evaluate the effect of optical body surface monitoring system(OSMS)in setup of intensity modulated radiotherapy(IMRT)for thoracic tumorsand to analyze its relationship with BMI.Methods Thesetup errors of CBCT and location CT with body membrane and the registration errors of OSMS and first body surface reference image without body membrane were obtained in 49 patients with thoracic tumor who received routine intensity modulated radiotherapy.The paired t-test was used to analyze the difference of registration errors between the two image guidance methods.Pearson′s correlation analysis was used to analyze the correlation between CBCT errors and OSMS errors,and Bland-Altman analysis was employed to evaluatethe agreement of the two errors.The correlation and consistency of the two registration errors in patients with different BMI index were analyzed.PTV external marginsby the two registration methods were calculated using Van Herk formula.Results The OSMS and CBCT groups demonstrated significant differences in setup errors in the ventrodorsal direction(P<0.05),while no significant differences were found in the left-right,head-foot translation directions,or RTN rota-tion directions(P>0.05).Although the two methods showed a significant correlation in setup errors(P<0.05),this correlation was only moderate in the head-foot and left-right directions(r=0.500,0.408),weak in the RTN rotation direction(r=0.339),and very weak in the ventrodorsal direction(r=0.152).The limits of agreement(LOA,95％CI)between the two methods were[-0.45,0.45]cm in the left-right direction,[-0.59,0.57]cm in the head-foot direction,and[-0.48,0.40]cm in the ventrodorsal direction,with(-2.08°～2.19°)in the RTN rotation direction.Different BMI levels influenced the results of the two registration methods,particularly in patients with a BMI of 18.5～23.9 kg/m2.In this group,OSMS and CBCT exhibited a strong correlation in the head-foot direction(r=0.731),a moderate correlation in the left-right direction(r=0.512),and weak correlations in the ventrodorsal and RTN rotation directions(r=0.345,0.267).The absolute difference in setup errors between the two imaging systems was 0.4～0.5 cm/2°.Using CBCT and OSMS image guidance,the margins in the left-right,head-foot,and ventrodorsal directions were[0.5 cm,0.7 cm,0.3 cm]for CBCT,and[0.5 cm,0.7 cm,0.5 cm]for OSMS.Conclusion In chest tumor patients with a BMI of 18.5～23.9 kg/m2,OSMS and CBCT image guidance methods show good correlation in the head-foot and left-right directions,but their limits of agreement exceed the clinically acceptable range.OSMS cannot yet replace CBCT for image guidance in chest tumor intensity-modulated radiotherapy.Further improvements to tumor motion surrogates are necessary to enhance the accuracy of OSMS image guidance.

Objective The purpose of writing the"expert consensus on humanistic care for patients in hospice care"(hereinafter referred to as the"consensus")aims to standardize the practice of humanistic care in the field of hospice care,ensuring that humanistic care is integrated throughout the entire service process for hospice care patients and their families.Methods A systematic search was conducted in domestic and foreign databases for literature related to hospice care and humanistic care,including guidelines,expert consensuses,systematic reviews or Meta-analyses,and evidence summaries.High-quality evidence was evaluated,extracted,and summarized to form the initial draft of the"consensus".From June to October 2024,20 experts from the fields of hospice care,nursing humanities,and evidence-based nursing were invited to participate in 1 round of expert consultation.Among them,13 experts were selected for 2 rounds of expert demonstration meetings.After collating and analyzing the experts' opinions,the initial draft was revised and refined,ultimately resulting in the final version of the"consensus".Results The effective response rate of the consultation questionnaire was 100％,with expert authority coefficient of 0.880,judgment coefficient of 0.935,and familiarity level of 0.825.The Kendall harmony coefficient of the expert consultation was 0.134(P＜0.05).The"consensus"consisted of 13 aspects,including the targets and objectives,principles,institutional guarantees,environmental requirements,etc.Conclusion This"consensus"possesses strong scientific rigor and practicality,which can provide guidance and references for the practice of humanistic care in the field of hospice care,promoting the standardization and humanization of hospice care services.

Objective To evaluate the effect of optical body surface monitoring system(OSMS)in setup of intensity modulated radiotherapy(IMRT)for thoracic tumorsand to analyze its relationship with BMI.Methods Thesetup errors of CBCT and location CT with body membrane and the registration errors of OSMS and first body surface reference image without body membrane were obtained in 49 patients with thoracic tumor who received routine intensity modulated radiotherapy.The paired t-test was used to analyze the difference of registration errors between the two image guidance methods.Pearson′s correlation analysis was used to analyze the correlation between CBCT errors and OSMS errors,and Bland-Altman analysis was employed to evaluatethe agreement of the two errors.The correlation and consistency of the two registration errors in patients with different BMI index were analyzed.PTV external marginsby the two registration methods were calculated using Van Herk formula.Results The OSMS and CBCT groups demonstrated significant differences in setup errors in the ventrodorsal direction(P<0.05),while no significant differences were found in the left-right,head-foot translation directions,or RTN rota-tion directions(P>0.05).Although the two methods showed a significant correlation in setup errors(P<0.05),this correlation was only moderate in the head-foot and left-right directions(r=0.500,0.408),weak in the RTN rotation direction(r=0.339),and very weak in the ventrodorsal direction(r=0.152).The limits of agreement(LOA,95％CI)between the two methods were[-0.45,0.45]cm in the left-right direction,[-0.59,0.57]cm in the head-foot direction,and[-0.48,0.40]cm in the ventrodorsal direction,with(-2.08°～2.19°)in the RTN rotation direction.Different BMI levels influenced the results of the two registration methods,particularly in patients with a BMI of 18.5～23.9 kg/m2.In this group,OSMS and CBCT exhibited a strong correlation in the head-foot direction(r=0.731),a moderate correlation in the left-right direction(r=0.512),and weak correlations in the ventrodorsal and RTN rotation directions(r=0.345,0.267).The absolute difference in setup errors between the two imaging systems was 0.4～0.5 cm/2°.Using CBCT and OSMS image guidance,the margins in the left-right,head-foot,and ventrodorsal directions were[0.5 cm,0.7 cm,0.3 cm]for CBCT,and[0.5 cm,0.7 cm,0.5 cm]for OSMS.Conclusion In chest tumor patients with a BMI of 18.5～23.9 kg/m2,OSMS and CBCT image guidance methods show good correlation in the head-foot and left-right directions,but their limits of agreement exceed the clinically acceptable range.OSMS cannot yet replace CBCT for image guidance in chest tumor intensity-modulated radiotherapy.Further improvements to tumor motion surrogates are necessary to enhance the accuracy of OSMS image guidance.

Objective To analyze the status of persistent human papillomavirus (HPV) infection and the distribution of viral subtypes in the Zhengzhou region. Methods Clinical data of 55239 patients who underwent HPV-DNA genotyping tests from 2018 to 2024 were collected. On the basis of HPV follow-up results, patients were divided into three groups: 849 cases of infection with the same HPV type, 255 cases of persistent infection with different HPV types, and 857 cases of transient HPV infection. Results Among the 9232 initially-screened patients who were positive with HPV, the high-risk HPV (HR-HPV) positive rate was 84.6% (7813/9232), and predominant subtypes were HPV-16 (20.8%), HPV-52 (17.2%), and HPV-53 (9.6%). The low-risk HPV (LR-HPV) positive rate was 15.4% (1419/9232), mainly HPV-81 (28.1%) and HPV-42 (27.0%). Among the 1961 follow-up cases, the rates of persistent and non-persistent infections with the same HPV type were 35.7% (701/1961) and 7.5% (148/1961), respectively. The rates of persistent and non-persistent infections with different HPV types were 10.9% (214/1961) and 2.1% (41/1961), respectively. Meanwhile, 43.7% (857/1961) tested negative upon follow-up. Among the 701 cases of persistent infection with the same HPV type, HR-HPV accounted for 85.7% (601/701), and LR-HPV accounted for 14.3% (100/701). Among the 214 cases of persistent infection with different HPV types, 89.7% (192/214) were high-risk transitions, and 10.3% (22/214) were low-risk transitions. Regardless of HPV types, HR-HPV was more likely to cause persistent infection than LR-HPV. In addition, over 60% of HR-HPV persistent infections resolved within 18 months, 30% developed into persistent infections, and only 15% of patients had persistent infections that last more than 24 months. Conclusion Persistent HPV infections are predominantly high-risk types. Most patients clear the infection within 18 months, approximately 30% develop persistent infections, and about 15% of patients have persistent infections that last more than 24 months. However, the HR-HPV persistent infection rates across different age groups slightly differ.

Objective The purpose of writing the"expert consensus on humanistic care for patients in hospice care"(hereinafter referred to as the"consensus")aims to standardize the practice of humanistic care in the field of hospice care,ensuring that humanistic care is integrated throughout the entire service process for hospice care patients and their families.Methods A systematic search was conducted in domestic and foreign databases for literature related to hospice care and humanistic care,including guidelines,expert consensuses,systematic reviews or Meta-analyses,and evidence summaries.High-quality evidence was evaluated,extracted,and summarized to form the initial draft of the"consensus".From June to October 2024,20 experts from the fields of hospice care,nursing humanities,and evidence-based nursing were invited to participate in 1 round of expert consultation.Among them,13 experts were selected for 2 rounds of expert demonstration meetings.After collating and analyzing the experts' opinions,the initial draft was revised and refined,ultimately resulting in the final version of the"consensus".Results The effective response rate of the consultation questionnaire was 100％,with expert authority coefficient of 0.880,judgment coefficient of 0.935,and familiarity level of 0.825.The Kendall harmony coefficient of the expert consultation was 0.134(P＜0.05).The"consensus"consisted of 13 aspects,including the targets and objectives,principles,institutional guarantees,environmental requirements,etc.Conclusion This"consensus"possesses strong scientific rigor and practicality,which can provide guidance and references for the practice of humanistic care in the field of hospice care,promoting the standardization and humanization of hospice care services.

Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.
Humans ; Consensus ; Dental Caries/etiology* ; Dental Enamel/pathology* ; Tooth Demineralization/etiology* ; Tooth Remineralization

OBJECTIVE To comprehensively assess the rationality and safety of clinical application of ceftazidime-avibactam(CAZ/AVI)so as to provide bases for reasonable and safe application of the drugs.METHODS A total of 137 patients who were hospitalized in Tianjin First Central Hospital and were treated with CAZ/AVI from Jan.2023 to Jan.2024 were recruited as the research subjects.The relevant informations involving the baseline da-ta,infection sites,etiological tests,status of drug utilization and adverse reactions were investigated and statically analyzed.The rating form was designed based on relevant guideline consensus and package insert,and the rational-ity and safety of clinical application of days were evaluated.RESULTS Totally 137 valid cases were enrolled in the study,88(64.23％)of whom were male,and 49(35.77％)were female,with the mean age(52±21.89)years old and the average medication duration(12.2±6.45)days.Totally 79 case-times of drug administration were un-reasonable,involving 75 patients;unsuited indications,unreasonable treatment course,absence of special consul-tation and ward round records and no curative effect evaluation after drug administration for 48-72 hours were the major manifestations.The total effective rate of CAZ/AVI treatment was 87.62％,5 patients had CAZ/AVI-associated adverse reactions,with the incidence of adverse reactions 3.65％.CONCLUSION It is necessary for the hospital to further standardize and optimize the clinical utilization of CAZ/AVI,strictly conform to the medica-tion indications,and strengthen the medication surveillance so as to raise the rationality and safety of medication.

Objective To investigate the effects of icariin on high glucose-induced autophagy and apoptosis of podocytes,and the regulating effects on mammalian target of rapamycin(mTOR)/serine-threonine kinase(Akt)/cyclic adenosine monophosphate response element binding protein(CREB)pathway.Methods The mouse podocytes MPC5 were taken and divided into five groups:normal control group(5.5 mmol·L-1 glucose),high glucose group(30 mmol·L-1 glucose),icariin group(30 mmol·L-1glucose+5 μmol·L-1icariin),GDC-0349 group(30 mmol·L-1glucose+50 μmol·L-1 GDC-0349),icariin+GDC-0349 group(30 mmol·L-1 glucose+5 μmol·L-1 icariin+50 μmol·L-1 GDC-0349).Cultured for 48 hours,the tetramethylazozolium salt method was used to detect the viability of MPC5 cells;acridine orange staining was used to observe the autophagy of MPC5 cells;apoptosis of MPC5 cells was detected by flow cytometry;Western blotting was used to detect the expression of autophagy[microtubule associated protein one light chain 3(LC3)II,LC3Ⅰ,autophagy-related protein(Beclin-1)],apoptosis[Bcl-2 related X protein(Bax),B cell lymphoma-2(Bcl-2)]and mTOR/Akt/CREB pathway-related proteins of MPC5 cells.Results Compared with the normal control group,the cell viability,expression levels of Bcl-2,phosphorylated mTOR(p-mTOR)/mTOR,phosphorylated Akt(p-Akt)/Akt,phosphorylated CREB(p-CREB)/CREB protein of MPC5 cells in the high glucose group were significantly decreased(P＜0.05),the autophagy ability was enhanced,the autophagosome showed orange fluorescence,and the apoptosis rate,LC3Ⅱ/LC3Ⅰ,Beclin-1,Bax protein expression levels were significantly increased(P＜0.05).Compared with the high glucose group,the cell viability,LC3Ⅱ/LC3Ⅰ,Beclin-1,Bcl-2,p-mTOR/mTOR,p-Akt/Akt,p-CREB/CREB protein expression levels of MPC5 cells in icariin group were significantly increased,the autophagy ability was further enhanced,the number of autophagosomes was increased,the autophagosomes showed brick red fluorescence(P＜0.05),the apoptosis rate and Bax protein expression level were significantly decreased(P＜0.05),and the cell viability,LC3Ⅱ/LC3Ⅰ,Beclin-1,Bcl-2,p-mTOR/mTOR,p-Akt/Akt and p-CREB/CREB proteins expression levels of MPC5 cells in GDC-0349 group were significantly decreased,the autophagy ability was weakened,the number of autophagosomes was reduced,the autophagosomes showed orange fluorescence(P＜0.05),and the apoptosis rate and Bax protein expression level were significantly increased(P＜0.05);icariin+GDC-0349 could reverse the effect of icariin on high glucose induced MPC5 cells(P＜0.05).Conclusion Icariin promotes elevated glucose-induced podocyte autophagy and inhibits apoptosis by activating the mTOR/Akt/CREB pathway.

Objective:To carry out genetic analysis on two families with carriers of small terminal translocations using karyotyping analysis and genomic copy number variation sequencing (CNV-seq).Methods:Two couples undergoing prenatal diagnosis at the Tianjin Central Hospital of Obstetrics and Gynecology respectively on April 12, 2020 and December 17, 2021 were selected as the study subjects. With informed consent, amniotic fluid and peripheral blood samples were collected and subjected to conventional karyotyping and CNV-seq analysis for the detection of chromosomal microdeletion/duplications.Results:Both couples had given births to children with chromosomal aberrations previously, and both fetuses were found to have abnormal karyotypes. CNV-seq showed that they had harbored microdeletion/duplications, and their mothers had both carried balanced translocations involving terminal fragments of chromosomes.Conclusion:For fetuses with small chromosomal segmental abnormalities, their parental origin should be traced, and the diagnosis should be confirmed with combined genetic techniques.