Background In 2021, chronic obstructive pulmonary disease (COPD) emerged as the forth leading cause of death in the world. However, the impact of air pollutants on COPD is still inconsistent across current studies. Objective To analyze the relationship between ambient sulfur dioxide (SO₂) exposure and hospital admissions for COPD in Lanzhou, and to examine the modified effects of SO₂ across different genders, age groups, and seasons. Methods A total of 20718 hospital admission records for COPD were collected from Lanzhou between 2016 and 2020, alongside synchronized data on SO₂ concentration and meteorological variables. A generalized additive model integrated with a distributed lag nonlinear model was used to assess the relationship and the lag effects between SO₂ exposure and COPD admissions. Potential confounders, including meteorological factors, day-of-the-week effect, and holidays, were controlled for, with a maximum lag period set at 7 d. Two-pollutant models and sensitivity analyses were conducted to ensure robustness. Results are expressed as relative risks (RR) with 95% confidence intervals (95%CI). Results During the study period, the average daily number of COPD admissions was 11.34±7.03. The average mass concentration of SO₂ was (23.72±12.35) μg·m⁻³. SO₂ exposure was positively correlated with COPD admissions; specifically, each 10 μg·m⁻³ increase in SO₂ concentration was associated with an RR of 1.440 (95%CI: 1.317, 1.573). Stratified analyses found that at a cumulative lag of 7 d, the RRs were higher among females, individuals aged ≥65 years, and during the cold season. Conversely, no significant increase in COPD admission risk related to SO₂ was observed during the warm season. For every 10 μg·m⁻³ increase in SO₂ concentration, the RR was 1.483 (95%CI: 1.311, 1.678) for females, 1.441 (95%CI: 1.311, 1.583) for those aged > 65 years， and 1.595 (95%CI: 1.313, 1.937) during the cold season. Conclusion Short-term exposure to ambient SO₂ exposure in Lanzhou is associated with an increased risk of COPD admission. The association is more pronounced among females, the elderly (aged> 65 years) and during the cold season.

Objective To evaluate the efficacy and safety of super-mini percutaneous nephrolithotomy(SMP)and standard percutaneous nephrolithotomy(sPCNL)in the treatment of 2-4 cm renal calculi, so as to provide reference for the management of medium-sized renal calculi. Methods A retrospective analysis was conducted on 168 patients with 2-4 cm renal calculi who underwent either SMP or sPCNL at our hospital during Sep. 2020 and Mar. 2025. The patients were divided into the SMP group(n=85)and sPCNL group(n=83). The baseline characteristics, stone features, operation time, perioperative complications, transfusion rate, postoperative hemoglobin drop, pain score, hospital stay, and stone-free rate(SFR)were compared between the two groups. Results There were no significant differences in baseline characteristics, stone features, and SFR between the two groups(P＞0.05). Compared to the sPCNL group, the SMP group had a longer operation time [(71.76±22.49)vs.(64.22±15.01)min, P=0.034]. However, it had lower postoperative pain score [(2.51 ±0.85)vs.(4.11±0.47), P＜0.001], shorter hospital stay [(3.16±1.45)vs.(4.30±1.06)days, P＜0.001], lower hospitalization costs [(19982.67±4267.80)vs.(21688.53±4575.74)RMB, P=0.004], a slighter decrease in hemoglobin [(6.64±10.56)vs.(12.22±11.50)g/L, P=0.032], and a significantly higher tubeless rate(83.53% vs. 0%, P＜0.001). There was no statistically significant difference in the overall complication rate between the two groups(P＞0.05). Conclusion For 2—4 cm renal calculi, SMP achieves a comparable SFR as sPCNL. Although the operation time with SMP is slightly longer, it offers significant advantages, including reduced postoperative pain, shorter hospitalization, lower costs, less bleeding, and a higher tubeless rate. SMP is a valuable technique worthy of broader clinical application.

OBJECTIVE: To investigate the influence of different scanning conditions on the image quality of medical electron accelerator cone-beam computed tomography (CBCT) and provide a reference for the selection of scanning conditions for different body parts. Methods Set different scanning conditions, the Catphan 503 phantom was scanned using CBCT parameters to analyze the influence of spatial resolution, noise, uniformity, spatial geometric accuracy, and low-contrast resolution on the image quality of CBCT. RESULTS: For the head, chest, and abdomen, with the increase in scanning parameter values, the noise value decreased by 47.4%, 26.1%, and 51.3% respectively, and the uniformity values decreased by 30.2%, 26.6%, and 47.9% respectively. The low-contrast resolution values decreased by 50.6%, 34.2%, and 12.0%. The influence of different scanning conditions on spatial geometric accuracy and spatial resolution is not significant. CONCLUSION Different scanning parameters have a certain influence on the image quality of medical electron accelerator CBCT. Lower scanning parameters can be selected based on individual patients to reduce the additional radiation dose, providing a reference for the safe application of CBCT image guidance in radiotherapy.
Cone-Beam Computed Tomography/instrumentation* ; Phantoms, Imaging ; Particle Accelerators

Allergen-specific immunotherapy（AIT） remains the only therapeutic approach with the potential to modify the natural course of allergic rhinitis（AR）. Nevertheless, considerable inter-individual variability exists in patients'responses to AIT. To facilitate more reliable assessment of treatment efficacy, the China Rhinopathy Research Cooperation Group（CRRCG） convened young and middle-aged nasal experts in China to formulate the present consensus. The recommended subjective outcome measures for AIT comprise symptom scores, medication scores, combined symptom and medication scores, quality-of-life assessments, evaluation of disease control, and assessment of comorbidities. Objective indicators may supplement these measures. Currently available objective approaches include skin prick testing, nasal provocation testing, and allergen exposure chambers. However, these methods remain constrained by practical limitations and are not yet appropriate for routine implementation in clinical efficacy evaluation. In addition, several biomarkers, including sIgE and the sIgE/tIgE ratio, sIgG4, serum IgE-blocking activity, IgA, cytokines and chemokines, as well as immune cell surface molecules and their functional activity, have been shown to have associations with AIT outcomes. While these biomarkers may complement subjective assessments, they are subject to significant limitations. Consequently, large-scale multicenter trials and real-world evidence are required to strengthen the evidence base. The present consensus underscores the necessity of integrating patients'subjective experiences with objective testing throughout the treatment process, thereby providing a more comprehensive and accurate framework for efficacy evaluation. Looking forward, future investigations should prioritize the incorporation of multi-omics data and artificial intelligence methodologies, which hold promise for overcoming current limitations in assessment strategies and for advancing both the standardization and personalization of AIT.
Humans ; Allergens/immunology* ; China ; Consensus ; Desensitization, Immunologic ; Immunoglobulin E ; Quality of Life ; Rhinitis, Allergic/therapy* ; Treatment Outcome ; East Asian People

Objective It aims to systematically review the concept of hospital digital maturity and its application in the digital transformation of hospitals,analyzes existing digital maturity assessment models internationally,and examine relevant research progress to provide reference and support for the digital transformation of Chinese hospitals.Methods By using the systematic review method,a systematic review was conducted by searching rele-vant literature in both Chinese and English databases,including CNKI,Wanfang Database,PubMed,Medline,and Web of Science.Keywords used for the search included digital maturity,digital capability,health,and hospital.Results Widely used international digital maturity assessment models encompass various dimensions,such as organizational management,digital technology capabilities,healthcare professional digital capabilities,data analytics,and interoperability.Some countries have applied these models in the digital transformation practices of hospitals,while attention to this field remains relatively limited in China.Conclusion Digital maturity assessment is a crucial tool for promoting the digital transformation of hospitals;however,existing evaluation frameworks are not directly appli-cable to China's public hospital system.Future research should focus on developing quantifiable assessment tools tai-lored to the characteristics of Chinese public hospitals,thereby promoting hospital digital transformation and high-quality development.

Objective:To compare and analyze the differences in positioning errors and placement outside the target area between two different image-guided systems(Halcyon and Synergy)in radiotherapy for cervical cancer.Methods:The data of 40 patients with cervical cancer who received treatment in Dezhou People's Hospital from March 2023 to June 2023 were retrospectively selected.Each patient was treated respectively with Halcyon linear accelerator and Synergy linear accelerator,with 20 cases for each treatment method.All patients underwent cone beam computed tomography(CBCT)at kV level to conduct image scanning before radiotherapy,and the obtained CBCT images were matched with the positioned CT images by online.The registration results of left and right(x),head and foot(y)and front and back(z)of three translation direction,and pitch(Rx),rotation(Ry)and deflection(Rz)directions of rotation direction were respectively obtained.The margin of planning target volume(MPTV)was calculated according to positioning expansion formula.The differences of positioning errors and target area expansion between Halcyon and Synergy image-guided systems were compared and analyzed.Results:Halcyon and Synergy image-guided systems obtained respectively 479 and 447 sets of CBCT images.The translational errors of Halcyon image-guided system on x,y,and z directions were respectively(-0.03±0.21),(0.12±0.63)and(0.02±0.15)cm,and the rotational errors of that on Rx,Ry and Rz directions were respectively(0.38±1.26)°,(-0.40±1.02)°,and(0.07±1.07)°.The translational errors of Synergy image-guided system were respectively(-0.07±0.18),(0.08±0.49)and(0.11±0.22)cm on the three directions,and the rotational errors of that were respectively(0.28±1.29)°,(-0.29±1.29)° and(-0.16±1.20)°.The translational error values on the y direction of both image-guided system were larger than that on x and z directions,and the absolute values of the range of translational errors of them were basically within 5 mm.There were no statistically significant difference in the positioning errors of rotation on Rx and Ry directions between Halcyon and Synergy image-guided systems(P＞0.05),while there was a statistically significant difference in the positioning error of rotation on Rz direction between them(t=-3.06,P＜0.05).The MPTV values of Halcyon image-guided system on x,y and z directions were respectively 0.4,1.4 and 0.3 cm,and those of Synergy image-guided system were respectively 0.4,0.9 and 0.5 cm.The expansion boundary of target area of Halcyon image-guided system on the y direction was larger than that of Synergy image-guided system,and that on other directions were all less or equal to 0.5 cm.Conclusion:The MPTV values of Halcyon and Synergy image-guided systems can meet clinical requirements in radiotherapy.The positioning errors and the tube current of the scan of Halcyon image-guided system were larger than those of Synergy image-guided system,but the scanning time and treatment time of that were significantly lower than those of Synergy image-guided system.Different treatment systems can be selected individually for patients according to their different conditions.

OBJECTIVE This study aims to investigate the epidemiological characteristics and influencing factors of skin diseases among soldiers performing duties and working in tunnel environments,and to propose targeted pre-ventive and therapeutic measures.METHODS A cross-sectional survey was conducted on 537 soldiers from multi-ple sites within a military unit from Nov.2022 to Oct.2023.The survey collected data on general information,liv-ing habits,and details of current skin diseases,including types,symptoms,duration and treatment status.Logis-tic regression analysis was applied to identify risk factors for the skin diseases observed.RESULTS A total of 21 types of skin diseases were identified,with dermatophyte infections being the most prevalent(59.96％,322/537),followed by acne(26.82％,144/537).Further analysis revealed that the incidence of dermatophyte infec-tions was closely associated with the region where the soldiers were stationed[OR(95％CI)=1.694(1.062,2.693),P=0.032]and the frequency of sock washing[OR(95％CI)=1.734(1.023,2.988),P=0.043],but no significant correlation was found between the prevalence of dermatophyte infections and the frequency of washing feet[OR(95％CI)=1.520(0.836,2.824),P=0.175].CONCLUSIONS This study highlights the epidemiological char-acteristics and key risk factors for skin diseases among soldiers in tunnel environments.Targeted prevention strategies are proposed,providing valuable scientific evidence for the prevention and control of skin diseases in similar environments.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Objective:To systematically evaluate the predictive value of the reverse shock index multiplied by the Glasgow coma scale score (rSIG) for mortality of trauma patients.Methods:A comprehensive literature search was conducted to identify studies on the predictive value of rSIG for mortality of trauma patients in the following databases from inception to April 2025, including CNKI, Wanfang Data, SinoMed, PubMed, Cochrane Library, Web of Science, and Embase. Two investigators independently screened the literature, extracted data, and assessed study quality according to predefined inclusion and exclusion criteria. The Quality assessment of diagnostic accuracy studies-2 (QUADAS-2) tool was used to evaluate the risk of bias in the included studies. Meta analysis was performed using Stata 17.0 software with a bivariate mixed-effects model. The following metrics were used to assess the predictive value of rSIG for mortality in trauma patients, including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (SROC) curve (AUC). The influence of various factors on the predictive performance of rSIG was examined, including injury type, study design, region, sample size, cut-off value, rSIG measurement time, and outcome measures. Additionally, sensitivity analysis, Fagan′s nomogram, and Deeks′ funnel plot were employed to assess the robustness of the findings, clinical applicability, and publication bias.Results:A total of 15 studies involving 710 612 trauma patients were included, 26 105 of whom were deceased. Meta analysis results showed that rSIG had a pooled sensitivity of 0.78(95% CI 0.71, 0.84), a pooled specificity of 0.78(95% CI 0.68, 0.86), a pooled PLR of 3.60(95% CI 2.46, 5.27), a pooled NLR of 0.28(95% CI 0.22, 0.36), a pooled DOR of 12.70(95% CI 8.10, 19.91), and an AUC of 0.85(95% CI 0.81, 0.87) for predicting mortality of trauma patients. Subgroup analysis identified injury type as one of the major sources of heterogeneity, and the predictive specificity of rSIG was significantly higher in patients with multiple trauma (0.82) than in those with isolated traumatic brain injury (0.65) ( P<0.05). Sensitivity analysis indicated that the findings were robust and stable. Fagan′s nomogram showed that when the pre-test probability was 7%, the post-test probability of death increased to 21% in patients with low rSIG and decreased to 2% in those with high rSIG. Deeks′ funnel plots suggested no significant publication bias among the included studies ( P>0.05). Conclusion:Low rSIG has good predictive performance for mortality of trauma patients and can serve as an effective tool for early and rapid prognosis assessment with superior predictive performance in patients with multiple trauma compared to those with traumatic brain injury.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.