Objective To evaluate the levels and changes in occupational individual external radiation dose in non-medical nuclear utilization units in Nanning City, and to provide a basis for radiation protection in such units. Methods Thermoluminescent dosimeters were used to monitor individual radiation doses among radiation workers in 38 non-medical nuclear utilization units in Nanning City. The results were subjected to statistical analysis. Results From 2021 to 2023, a total of 3724 person-times were monitored in 38 non-medical nuclear utilization units in Nanning City. The mean annual effective dose was 0.101 mSv in 2021, 0.060 mSv in 2022, and 0.094 mSv in 2023, with a three-year average of 0.085 mSv, all well below the occupational exposure limit of 1.0 mSv. Significant differences in mean annual effective doses were observed across occupations and sexes (P<0.05). Female workers received significantly lower mean annual effective dose than male workers. Workers in the cement manufacturing industry had a significantly higher mean annual effective dose compared to those in government institutions and industrial flaw detection practitioners (F = 2.913, P<0.05). No significant differences were found among workers exposed to unsealed radioactive sources, sealed radioactive sources, and radiation-generating equipment (F = 0.585, P>0.05). Conclusion The occupational individual external radiation doses in non-medical nuclear utilization units in Nanning City are at low levels. There are no significant differences in mean annual effective dose across different nuclear utilization units. However, differences in occupational roles between males and females significantly affect the mean annual effective dose.

Background/Aims: Natural killer (NK) cell function is generally considered dampened in chronic hepatitis B virus (HBV) infection; however, the NK cell pool exhibits phenotypic and functional heterogeneity, and the antibody--mediated effect of NK cells remains less characterized. This study evaluated the dynamic changes in antibody-mediated NK cell responses and the involvement of distinct NK subsets across disease stages and during antiviral treatment. Methods: A T-cell receptor-like antibody specific for the HBV core 18–27 peptide (cTCRL-Ab) was used to determine the antibody-mediated effect of NK cells, and an array of NK cell surface markers were analyzed in cross-sectional and longitudinal cohorts of patients with chronic HBV infection. Single-cell RNA sequencing (scRNA-seq) was performed to identify the heterogeneity of NK subsets. Results: The cTCRL-Ab enabled the detection of NK cell cytolytic activity and IFNγ production. Notably, cTCRL-Ab-mediated NK cell responses were compromised in chronically HBV-infected patients, particularly in those receiving pegylated interferon-α (Peg-IFNα), which was associated with the downregulation of CD16 expression. Correspondingly, Peg-IFNα inhibited cTCRL-Ab-mediated NK cell function by reducing CD16 expression in vitro. scRNA-seq revealed that CD16 downregulation occurred mainly within a dysfunctional CD16hi NK subset exhibiting exhaustion properties. In contrast, an activated CD16hiNK subpopulation (CX3CR1⁺KLRC2–CD16hi) with high cytotoxicity was enriched in patients who experienced favorable treatment responses. Furthermore, the intrahepatic CX3CR1+KLRC2–CD16hi subset tended to exhibit functional restoration in HBsAg-loss individuals. Conclusions Our data contribute to the understanding of antibody-mediated responses of NK cells in chronic HBV infection, and highlight a previously unappreciated functional CX3CR1+KLRC2–CD16hiNK subset as a potential therapeutic target.

Objective:To analyze the medication law of Professor Liu Guangzhen in the treatment of diabetic nephropathy (DN) with qi-yin deficiency and blood stasis syndrome using data mining methods.Methods:From March 2023 to April 2024, the TCM outpatient prescriptions used by Professor Liu to treat DN with qi-yin deficiency and blood stasis syndrome were collected. The database was established by Excel 2019, and the property, taste, meridian, and use frequency of drugs were analyzed through the TCM inheritance assistance system V2.5. The Apriori algorithm in IBM SPSS Modeler 18.0 was used to analyze the association rules and draw the network diagram of high-frequency drugs, and the two-step hidden tree analysis algorithm (LTM-EAST) in the Lantern 5.0 was used to establish the hidden structure model of high-frequency Chinese materia medica. The obtained hidden variables were clustered and interpreted comprehensively, and scored by Bayesian information measure (BIC).Results:A total of 314 prescriptions were included, involving 182 kinds of Chinese materia medica, with a total frequency of 9 242 times. High frequency Chinese materia medica included Astragali Radix, Saposheikovize Radix, Atractylodis Macrocephalae Rhizoma fried with wheat bran, Litchi Semen, Hedyotis diffusa willd, Benincasae Exocarpium, Mori Folium, etc. The medicinal property was mainly warm, the tastes were mainly sweet, bitter and pungent, and the meridian tropism was mainly spleen, stomach, liver and kidney meridians. The efficacy classification was mainly tonic drugs, heat-clearing drugs, water-clearing and dampness-percolating drugs, and blood circulation-activating drugs. There were 150 association rules of high-frequency Chinese materia medica, including Astragali Radix-Saposheikovize Radix, Atractylodis Macrocephalae Rhizoma fried with wheat bran-Hedyotis diffusa willd, Saposheikovize Radix-Benincasae Exocarpium, etc. A total of 15 hidden variables, 30 hidden classes and 5 comprehensive clustering models were obtained by hidden structure model analysis.Conclusions:Professor Liu's treatment of DN withqi-yin deficiency and blood stasis syndrome is mainly based on tonifying qi and yin, tonifying spleen and kidney, removing dampness and turbidity and removing blood stasis. According to different conditions, the focus of medication has changed.

We report a family with multiple endocrine neoplasia type 1(MEN1), in which the proband presented with primary amenorrhea and was diagnosed with both a pituitary prolactinoma and an ACTH-secreting adenoma. Genetic testing identified a heterozygous MEN1 gene c. 1449_1476del mutation in the proband, as well as in six additional family members, who exhibited variable clinical phenotypes. Following initial transsphenoidal pituitary surgery, the proband's symptoms and biochemical abnormalities persisted, with elevated ACTH and cortisol levels. Functional imaging using [ 68Ga]-DOTA-TATE PET/CT confirmed residual pituitary tumor tissue, and a second surgery resulted in biochemical remission.

Objective:To analyze the genetic characteristics of the prevalent strains of Varicella-Zoster virus (VZV) in the population of Dali, Yunnan, and to understand its evolutionary status in the population of Dali.Methods:Herpes fluid and 163 sera were collected from 249 patients clinically suspected to have varicella or herpes zoster in the Department of Dermatology of the Second People′s Hospital of Dali city, Yunnan province, China, from 2023 to 2024. The levels of VZV-specific IgG and IgM antibodies in serum were detected using enzyme-linked immunoassay. Viral DNA was extracted from the herpes fluid, and the cycle threshold ( Ct) of the samples was detected using quantitative real-time polymerase chain reaction (qPCR), and some samples with Ct ≦ 22 were selected for sequencing by next-generation sequencing technology (next-generation sequencing). Next-generation sequencing (NGS) was used to obtain 90 whole genome sequences of VZV, and the sequencing result were compared with the sequences of reference strains for multiple sequence comparison and evolutionary analysis. Snapgene was used to translate the nucleotides into amino acids, and the result were compared with the amino acid sequences of the reference strain. Results:Of the 90 VZV whole-genome sequences, one whole-genome sequence was from an adult varicella patient, and the remaining 89 whole-genome sequences were from herpes zoster patients. The serum-specific IgG antibody positivity rate was 99.4%, and the IgM antibody positivity rate was 52.8%. The result of both single nucleotide polymorphism (SNPs) site typing and genome-wide phylogenetic tree analysis showed that 83 of the 90 VZV whole-genome sequences in this study were on the same branch as Clade 2, and 7 VZV whole-genome sequences were on the branch of Clade 9.Conclusions:The main endemic branch in Dali region in 2023-2024 was Clade 2, with the emergence of Clade 9 branch; there were amino acid mutations in the proteins encoded by ORF22 and ORF68 in 83 VZV whole genome sequences of Clade 2 branch, and the mutations did not cause significant changes to the protein structure.

Objective:To explore and evaluate the effectiveness of integrating standardized patient cases with simulation-based teaching in internship teaching in the department of obstetrics and gynecology.Methods:This study enrolled 60 interns from the Department of Obstetrics and Gynecology at Hangzhou First People's Hospital between January 2022 and December 2023. Participants were randomly assigned using a random number table into a control group (simulator training) and an experimental group (simulated standardized patient consultation integrated with simulation training). Simulation-based teaching was performed for seven skill modules. After training, participants underwent both skill assessments and questionnaire surveys. Skill assessment scores, professional competencies, and self-evaluation outcomes were compared between the two groups.Results:In skill assessments for delivery [(90.50±5.51) vs. (84.90±5.30)], I° perineal laceration repair [(91.98±6.87) vs. (84.18±10.24)], abortion[(90.43±6.79) vs. (84.10±5.36)], and diagnostic curettage [(92.57±8.19) vs. (85.80±8.61)], the experimental group scored significantly higher than the control group ( P<0.05). The experimental group showed higher scores in demonstrating empathy [53.33% (16/30) vs. 23.33% (7/30), P<0.05] and prioritizing doctor-patient communication [96.67% (29/30) vs. 46.67% (14/30), P<0.01]. Additionally, the experimental group reported higher scores in course satisfaction [(9.48±0.50) vs. (9.02±0.45)], performance self-assessment [(9.17±0.35) vs. (8.65±0.27)], engagement during simulation-based training [(9.62±0.43) vs. (8.43±1.21)], and learning gains [(9.53±0.87) vs. (8.88±1.02)]. Conclusions:Compared to simulation-based teaching alone, the integration of standardized patient cases can improve learning outcomes for complex and comprehensive skill modules and contribute to the development of professional competencies.

Objective Explore a comprehensive and multi-level set of passive defensive medical governance strate-gies.Methods Literature related to passive defensive medical governance was retrieved,and the Ucinet social net-work analysis software was utilized to calculate indicators such as the frequency and centrality of passive defensive medical governance strategies,thereby understanding the importance of these strategies.Results The formed set of negative defensive medical governance strategies covers three levels social cogniton,institutional mechanisms and doctor-patient relationship.Among them,there are 5 governance strategies at the social cognition level,24 governance strategies at the institutional mechanism level,and 12 governance strategies at the doctor-patient rela-tionship level,totaling 41 governance strategies.Conclusion The constructed set of passive defensive medical governance strategies is scientific,practical,and comprehensive in content,providing a reference framework for medical institutions to govern passive defensive medical behaviors.

Objective Based on the WSR methodology,a three-dimensional integrated perspective of Wuli,Shi-li,and Renli dimensions was used to sort out the logical relationships and architectures among negative defensive medical governance strategies,forming the priority governance strategies for improving negative defensive medical care.Methods Based on the literature research method and the expert consultation method,the governance strate-gy and the conceptual connotation of WSR are classified into items,and the role relationship in the complex sys-tem of passive defensive medical governance is clarified through the WSR methodology.Results A collection of 40 negative defensive medicine governance strategies has been developed,comprising 8 strategies in the Wuli dimen-sion,23 strategies in the Shili dimension,and 9 strategies in the Renli dimension.Conclusion The WSR methodology provides a three-dimensional systemic perspective for governance strategies against negative defen-sive medicine.Addressing this issue requires comprehensive and systematic governance strategies.

BACKGROUND:Psoralen has a strong anti-osteoporotic activity and may have a restorative effect on chemotherapy-induced osteoporosis. OBJECTIVE:To explore the restorative effect of psoralen on the osteogenic differentiation of bone marrow mesenchymal stem cells in mice inhibited by cyclophosphamide and its mechanism. METHODS:C57BL/6 mouse bone marrow mesenchymal stem cells were isolated and cultured.Effect of psoralen on viability of bone marrow mesenchymal stem cells was detected by MTT assay.Osteogenic induction combined with alkaline phosphatase staining was used to determine the optimal dose of psoralen to restore the osteogenic differentiation of bone marrow mesenchymal stem cells inhibited by cyclophosphamide.The mRNA expression levels of Runx2,alkaline phosphatase,Osteocalcin,osteoprotegerin,and Wnt/β-catenin signaling pathway-related genes Wnt1,Wnt4,Wnt10b,β-catenin,and c-MYC were measured by RT-qPCR at different time points under the intervention with psoralen.The protein expression of osteogenic specific transcription factor Runx2 and Wnt/β-catenin signaling pathway related genes Active β-catenin,DKK1,c-MYC,and Cyclin D1 was determined by western blot assay at different time points under the intervention with psoralen. RESULTS AND CONCLUSION:(1)There was no significant effect of different concentrations of psoralen on the viability of bone marrow mesenchymal stem cells.The best recovery of the inhibition of osteogenic differentiation of bone marrow mesenchymal stem cells caused by cyclophosphamide was under the intervention of psoralen at a concentration of 200 μmol/L.(2)Psoralen reversed the reduction in osteogenic differentiation marker genes Runx2,alkaline phosphatase,Osteocalcin and osteoprotegerin mRNA expression and Runx2 protein expression in bone marrow mesenchymal stem cells caused by cyclophosphamide conditioned medium.(3)Psoralen reversed the decrease in Wnt/β-catenin pathway-related genes Wnt4,β-catenin,c-MYC mRNA and Active β-catenin,c-MYC,and Cyclin D1 protein expression and the increase in DKK1 protein expression in bone marrow mesenchymal stem cells caused by cyclophosphamide conditioned medium.(4)The results showed that cyclophosphamide inhibited osteogenic differentiation of bone marrow mesenchymal stem cells in mice,and psoralen had a restorative effect on it.The best intervention effect was achieved at a concentration of 200 μmol/L psoralen,and this protective effect might be related to the activation of Wnt4/β-catenin signaling pathway by psoralen.

Objective To explore the clinical effectiveness of a locally trained and re-optimized RapidPlan model in lung stereotactic body radiation therapy (SBRT). Methods A total of 132 lung SBRT cases were retrospectively collected as a training group for the establishment of an initial RapidPlan model (RP-1) in the Eclipse 15.5 treatment planning system. RP-1 was then used to optimize the training group plans to generate the first-generation RapidPlans, which were used as a new training group to generate the upgraded RapidPlan model (RP-Plus). Additional 40 lung SBRT cases were selected to verify the quality and efficiency of RP-Plus plans, which were further assessed through clinical quality assurance (QA). Results The RP-Plus reduced the average number of optimization cycles by 2.1 times and 0.3 times compared to manual and RP-1 methods, respectively, and reduced the optimization time by 57.6% and 18.8%. The conformity index met clinical requirements, and the gradient index and Max_2cm(%) were improved compared to RP-1 (both P < 0.05). The RP-Plus plans showed lower dosimetric parameters of organs at risk, including lung V_20Gy, spinal cord D_max, and heart \begin{document}$D_{0.1{\mathrm{cm}}^3} $\end{document} The clinical QA pass rate of the RP-Plus plans was 100%. Conclusion The locally trained and re-optimized lung SBRT RapidPlan model can further improve plan quality and efficiency, and meet clinical QA requirements, showing feasibility for clinical application.