The 3D-printed radiotherapy X-ray dose compensators can significantly improve the spatial accuracy of radiation dose distribution and the homogeneity of the target volume in superficial tumor radiotherapy while reducing the dose to normal tissues by conforming to individual patient surface contours. Their clinical application value is becoming increasingly prominent. However, standardized evaluation systems or technical specifications for such products are currently lacking both domestically and internationally, leading to inconsistent performance assessment and hindering the verification of their clinical safety and effectiveness. To ensure radiotherapy quality and patient health and safety, this study proposed a set of technical specifications for evaluating radiotherapy X-ray dose compensators by reviewing their physical, functional, and safety performance, as well as software and clinical-engineering interaction performance. Furthermore, based on existing technical standards and regulatory review guidelines, quantitative evaluation methods were explored, including computed tomography number calibration phantom testing and dose compensation performance verification. This work aims to provide a scientific reference for future product development, standard formulation, and regulatory review.

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.

Metabolic dysfunction-associated fatty liver disease （MAFLD） has become the most common chronic liver disease worldwide. Its pathological process is centered on the “two-hit” theory， with gut-liver axis dysregulation running through the entire disease course from steatosis to liver cirrhosis and even hepatocellular carcinoma， and it forms an extensive cross-system regulatory mechanism with the metabolic， cardiovascular， renal， and psychological and nervous systems through multi-dimensional pathways such as the “gut-liver-brain axis”， the “liver-kidney axis”， and the “liver-heart axis”. Disease progression is not limited to the liver itself， and it also involves functional imbalance of multiple organ systems throughout the body. This article systematically elaborates on the association mechanism of “liver pathological progression-multi-axis regulation-comorbidity occurrence” in MAFLD， proposes synergistic management strategies integrating early screening based on risk stratification， targeted intervention， and multidisciplinary diagnosis and treatment， and analyzes the limitations of current research and future development directions， in order to provide a theoretical basis and practical guidance for precise diagnosis and treatment and individualized management of MAFLD.

Objective To determine the optimal extraction process for kaempferol from Alpinia officinarum Hance and to investigate its antioxidant activity.Methods Based on single-factor experimental data,this study employed the Box-Behnken central composite design and response surface methodology(RSM),combined with high-performance liquid chromatography(HPLC),to plot response surface and contour maps using kaempferol content as the response value.The optimal parameters for ethanol concentration,solid-liquid ratio,extraction time,and extraction temperature were selected.The antioxidant activity of kaempferol was comprehensively evaluated by calculating the radical scavenging rate using the DPPH radical scavenging assays.Results The optimal extraction conditions were determined to be an ethanol concentration of 84%,a solid-liquid ratio of 1∶80,an extraction time of 2 hours,and an extraction temperature of 82℃.Under these conditions,the kaempferol content extracted from Alpinia officinarum Hance reached 0.034 16%.In the DPPH radical scavenging assay,the extract showed a scavenging rate of 91.20%at a concentration of 1 mg/mL.Conclusion The optimized extraction process for kaempferol from Alpinia officinarum Hance was obtained using the Box-Behnken response surface design method,and this process is practical and feasible.The DPPH radical scavenging assay demonstrated that kaempferol from Alpinia officinarum Hance possesses antioxidant activity.

Objective To understand the changes in self-rated health among middle-aged and elderly individuals in China and the influencing factors,providing a reference for improving health and promoting healthy aging.Methods Using data from the China Health and Aged Care Tracking Survey(CHARLS)from 2011 to 2020,this study analyzed 3595 middle-aged and elderly individuals(≥45 years old)who participated in all five rounds of the survey from 2011 to 2020.Univariate analysis and multinomial logistic regression were employed to analyze the influencing factors of self-rated health changes.Results Among the 3 595 middle-aged and elderly individuals,26.54％reported an increase in self-rated health,28.40％reported a decrease,and 45.06％reported no change.The multinomial logistic regression results indicated that compared to those with unchanged self-rated health,individuals whose self-rated health declined were more likely to have an increased number of Activities of Daily Living(ADLs),a higher number of chronic diseases,not engaging in at least 10 minutes of light physical activity per week,and a decline in life satisfaction levels.The odds ratios for these factors were 1.415(OR=1.415,95％CI:1.181～1.694),1.479(OR=1.479,95％CI:1.225～1.785),1.454(OR=1.486,95％CI:1.172～1.804),and 1.263(OR=1.237,95％CI:1.043～1.530),respectively.In contrast,individuals whose self-rated health improved,compared to those with unchanged health,were more likely to report an increase in life satisfaction levels,while an increase in ADLs and chronic diseases negatively impacted self-rated health improvement.The odds ratios for these factors were 1.698(OR=1.698,95％CI:1.425～2.023),0.769(OR=0.769,95％CI:0.646～0.915),and 0.689(OR=0.689,95％CI:0.549～0.865),respectively.Conclusion From 2011 to 2020,the self-rated health of middle-aged and elderly individuals in China has slightly declined,with a focus on improving physical health status,increasing physical activity,and addressing mental health as key areas for enhancing self-rated health among the elderly in China.

Objective To investigate the effectiveness of the curriculum design and teaching mode reform in Health Statistics through the assessment by postgraduate students so as to enhance the teaching performance of the course.Methods A questionnaire survey was conducted among the postgraduate students of grade 2023 at a certain medical university.The survey covered such aspects as students'mastery and application of the course learning content,their evaluation and satisfaction with the course,etc.Descriptive approaches were employed to analyze and summarize the data.Results Students achieved a good command of theoretical knowledge and its application.They highly evaluated the teacher,the course content and its practicality,demonstrated a strong interest in learning,expressed a high level of satisfaction with the course,and manifested a strong willingness to continue studying the course.The learning of the course met the expectations of the students.The final exam scores in the later stage of curriculum reform(78.60±10.58)was higher than that before the reform(75.78±7.97,P<0.05);the excellent rate after the reform was 53.6%,which was higher than the 33.5%before the reform(P<0.05).Conclusion The construction of a course system that integrates knowledge,skills the mixed teaching mode of case-based teaching and the combination of theory and statistical software package operation are beneficial for enhancing postgraduate students'learning and application of the course in health statistics.It also strengthens the design and training of course application aspects for students in clinical medicine and dental medicine disciplines.

Cholesterol(CH)plays a crucial role in enhancing the membrane stability of drug delivery systems(DDS).However,its association with conditions such as hyperlipidemia often leads to criticism,overshadowing its influence on the biological effects of formulations.In this study,we reevaluated the delivery effect of CH using widely applied lipid microspheres(LM)as a model DDS.We conducted comprehensive in-vestigations into the impact of CH on the distribution,cell uptake,and protein corona(PC)of LM at sites of cardiovascular inflammatory injury.The results demonstrated that moderate CH promoted the accumulation of LM at inflamed cardiac and vascular sites without exacerbating damage while partially mitigating pathological damage.Then,the slow cellular uptake rate observed for CH@LM contributed to a prolonged duration of drug efficacy.Network pharmacology and molecular docking analyses revealed that CH depended on LM and exerted its biological effects by modulating peroxisome proliferator-activated receptor gamma(PPAR-γ)expression in vascular endothelial cells and estrogen receptor alpha(ERα)protein levels in myocardial cells,thereby enhancing LM uptake at cardiovascular inflam-mation sites.Proteomics analysis unveiled a serum adsorption pattern for CH@LM under inflammatory conditions showing significant adsorption with CH metabolism-related apolipoprotein family members such as apolipoprotein A-V(Apoa5);this may be a major contributing factor to their prolonged circu-lation in vivo and explains why CH enhances the distribution of LM at cardiovascular inflammatory injury sites.It should be noted that changes in cell types and physiological environments can also influence the biological behavior of formulations.The findings enhance the conceptualization of CH and LM delivery,providing novel strategies for investigating prescription factors' bioactivity.

Objective:To retrieve, evaluate and integrate the evidence related to postoperative exercise rehabilitation for hip fracture in elderly frail patients, and provide reference for clinical rehabilitation nursing.Methods:Evidence on postoperative exercise rehabilitation of hip fractures in elderly frail patients was systemically retrieved in the guideline websites, professional association websites and databases, such as BMJ Best Practice, UpToDate, PubMed, Web of Science, CINAHL, Cochrane Library, Embase, Chinese Biomedical Database, China National Knowledge Infrastructure, Wanfang and VIP, including Best practices, guidelines, clinical decisions, evidence summaries, systematic reviews, and expert consensus. The retrieval time was from the establishment of the database to March 31, 2024.Results:A total of 33 articles were involved, including 12 guidelines, 2 clinical decisions, 7 systematic reviews, 7 expert consensuses, 5 evidence summaries. Forty pieces of evidence were summarized in 7 aspects: the role of exercise, exercise assessment, exercise planning, exercise content, exercise intensity, exercise adherence, exercise nursing, exercise guidance.Conclusions:Healthcare professionals should combine patients' tolerance, rehabilitation goals, and specific clinical situations to target and guide patients in exercise rehabilitation to promote the recovery of postoperative limb function, mitigate frailty, and improve the quality of life.

Objective:To compare the diagnostic value of contrast-enhanced ultrasound(CEUS)combined with conventional ultrasound and magnetic resonance imaging(MRI)in distinguishing benign and malignant non-mass lesions of breast.Methods:A retrospective analysis was conducted on 131 patients with non-mass lesions of breast(76 benign cases,55 malignant cases),who were pathologically confirmed at The 910th Hospital of People's Liberation Army Joint Service Support Force from January 2019 to January 2024.The CEUS and MRI characteristics between benign and malignant non-mass lesions of breast were compared.Using pathological results as the gold standard,the receiver operating characteristic(ROC)curve were employed to compare the area under curve(AUC)value,sensitivity and specificity of CEUS+conventional ultrasound and MRI in diagnosing malignant non-mass lesions of breast.The diagnostic performances of them on non-mass lesions with different sizes(maximum diameter<10 mm,10-20 mm,and>20 mm)were further explored.Results:Conventional ultrasound identified 131 non-mass lesions of breast,whereas MRI identified 79 non-mass lesions(60.31%),40 cases with mass-like lesions(30.53%),and 12 normal breast(9.16%).The overall consistency between conventional ultrasound and MRI was higher(Kappa=0.603).After CEUS combined with conventional ultrasound,38 lesions that were classified as BI-RADS 4 by conventional ultrasound downgraded to BI-RADS 3.In the 131 patients,the specificity(71.1%)of CEUS combined with conventional ultrasound was significantly higher than that(55.3%)of MRI,with a statistically significant difference(x2=5.775,P=0.016).For all patients,the AUC value(0.828)of CEUS combined with conventional ultrasound in diagnosing malignant non-mass lesions of breast was higher than that(0.776)of MRI(Z=3.246,P=0.006).Among of them,the diagnostic AUC value of CEUS combined with ultrasound was 0.842 for the patients whose size of the non-mass lesions of breast was between 10-20 mm,which was significantly larger than that(0.758)of MRI(Z=4.856,P<0.001).Conclusions:The diagnostic specificity of CEUS+conventional ultrasound is higher than that of MRI for malignant non-mass lesions of breast,which has a certain of advantage.

Objective To investigate the effect of differentdoses of oxycodone on postoperative recovery quality in elderly patients undergoing laparoscopic cholecystectomy.Methods Elderly patients scheduled for elective laparoscopic cholecystectomy at Mianyang Central Hospital from September 2023 to April 2024 were selected.Patients were randomly divided into group C,group O1 and group O2.Ten minutes before anesthesia induction,group O1 received intravenous oxycodone 0.05 mg·kg-1,group O2 received oxycodone 0.1 mg·kg-1,and group C received an equivalent volume of 0.9%sodium chloride.Observe and compare the scores of the Quality of Recovery-40(QoR-40)scale at 24 hours postoperatively,the Visual Analogue Scale(VAS)for pain at 10 minutes postoperatively and incidence of postoperative respiratory amnesia among the three groups.Multiple linear regression analysis was used to investigate the effect of hydrocodone on postoperative QoR-40 score.Results A total of 117 patients were included,39 in each group.According to the dropout criteria,a total of 34 cases were included in the group C,38 cases in group O1,and 38 cases in group O2.Compared to group C,group O1 and O2 showed significantly higher QoR-40 scores at 24 hours postoperatively(P<0.01),particularly in physical comfort,emotional state,independent functioning,and pain(P<0.05 or P<0.01).However,there was no significant difference between group O1 and O2(P>0.05).Both oxycodone groups had significantly lower 10-minute postoperative VAS scores than group C(P<0.05).Group O1 had a lower incidence of respiratory amnesia than group O2(P<0.05).Multivariate regression revealed that oxycodone use,age,postoperative nausea/vomiting,and 10-minute VAS scores collectively explained 69%of the variance in QoR-40 scores at postoperatively(adjusted R2=0.69),with oxycodone use significantly improving QoR-40 scores at postoperatively[β=9.336,95%CI(7.428,11.243),P<0.001].Conclusion Preoperative intravenous administration of oxycodone improves the quality of recovery in elderly patients after laparoscopic cholecystectomy.The incidence of postoperative respiratory amnesia was lower in 0.05 mg·kg-1 oxycodone dose group.