Definitive treatment of lung cancer with radiotherapy is challenging, as respiratory motion and anatomical changes can increase the risk of severe off-target effects during radiotherapy. Online adaptive radiotherapy (ART) is an evolving approach that enables timely modification of a treatment plan during the interfraction of radiotherapy, in response to physiologic or anatomic variations, aiming to improve the dose distribution for precise targeting and delivery in lung cancer patients. The effectiveness of online ART depends on the seamless integration of multiple components: sufficient quality of linear accelerator-integrated imaging guidance, deformable image registration, automatic recontouring, and efficient quality assurance and workflow. This review summarizes the present status of online ART for lung cancer, including key technologies, as well as the challenges and areas of active research in this field.
Humans ; Lung Neoplasms/radiotherapy* ; Radiotherapy Planning, Computer-Assisted/methods*

Objective:To explore the application of three-level task-driven teaching based on motivational regulation strategy in training nurse interns in the Department of Clinical Psychology.Methods:This study included 80 nurse interns in the Department of Clinical Psychology at Zhejiang Provincial People's Hospital between June 2021 and May 2024 as research subjects. They were divided into a control group ( n=40) and an experimental group ( n=40). The control group received traditional teaching, while the experimental group received three-level task-driven teaching based on motivational regulation strategy, covering basic knowledge mastery, practical operation improvement, and comprehensive ability enhancement. Through scenario guidance and simulation exercises, the intrinsic motivation of nurse interns was stimulated. The assessment scores, self-learning ability, teaching quality, and recognition of teaching were compared between the two groups of nurse interns. Results:After teaching, the experimental group scored higher than the control group on theoretical assessment [(86.05±5.86) vs. (74.35±4.72)] and operational skill assessment [(88.18±5.67) vs. (82.65±6.09)] ( P<0.001). The total score and scores of various dimensions of teaching quality were higher in the experimental group compared to those in the control group ( P<0.001). After teaching, the total score and scores of various dimensions of self-learning ability of both groups were higher than those before teaching, and the scores were higher in the experimental group than in the control group ( P<0.05). Conclusions:The three-level task-driven teaching based on motivational regulation strategy can significantly improve the assessment scores, self-learning abilities, and teaching quality of nurse interns in the Department of Clinical Psychology. Additionally, this method can enhance their recognition of nursing internship teaching. This teaching method is worth promoting.

Objective To investigate the effects of implant length,diameter,and abutment angle on bone stress distributions around maxillary central incisors,and determine the optimal parameter combination.Methods A three-dimensional(3D)model of the maxilla was reconstructed based on CBCT data.Using an orthogonal table,a total of 16 dental implant 3D models were established,varying in length,diameter,and abutment angle.These models were assembled with the maxillary and rigid-body models.Finite element analysis was performed using the transient dynamics module of ANSYS.Orthogonal experiments and one-way analysis of variance(ANOVA)were conducted on the obtained stress data.Results The implant diameter showed a statistically significant effect on the maximum von Mises stress in cortical bone(P=0.010),while implant length(P=0.229)and abutment angle(P=0.844)did not demonstrate a statistical significance.The optimal parameter combination for cortical bone stress was 5.0 mm implant diameter,12 mm implant length,and 0° abutment angle.In cancellous bone,implant length(P=0.001),diameter(P=0.011),and abutment angle(P=0.013)all had statistically significant effects on the maximum von Mises stress.The optimal parameter combination for cancellous bone stress was 14 mm implant length,5.0 mm implant diameter,and 5° abutment angle.Conclusions Implant diameter significantly affects the stress of both cortical and cancellous bone.Clinically,a larger diameter should be preferred to reduce the stress peak.Implant length is the next most important factor,while abutment angle has the least effect.

Objective To analyze the main epidemiological characteristics of fungal infection in this hospital in the past 7 years,and to provide reference for clinical treatment and prevention and control strategies of fun-gal infection.Methods The fungal data and clinical data of related patients isolated from clinical samples in Peking Union Medical College Hospital from early January 2018 to the end of May 2024 were selected,and the main epidemiological characteristics of fungal infection in this hospital were identified and described through multi-angle statistical analysis.Results A total of 4 479 patients with filamentous fungal infection were en-rolled.The proportion of male patients[57.5％(2 576/4 479)]was higher than that of female patients[42.5％(1 903/4 143)],mainly distributed in internal medicine,Intensive Care Unit(ICU)and emergency de-partment,among which internal medicine accounted for the highest proportion[50.0％(2 241/4 479)].About 90.0％of the specimens were from the lower respiratory tract,in addition to specimens from skin and soft tis-sue,tissue,ear and blood culture.In terms of seasonal distribution,there are more patients in winter.The fun-gi were mainly composed of Aspergillus,Mucor,Cerdosporium,Fusarium and Penicillium,among which As-pergillus was the most abundant,accounting for 74.6％of the total.Aspergillus fumigatus was the most a-bundant Aspergillus,accounting for 42.5％of the total Aspergillus(1 418/3 340).Among the related infec-tions caused by mold,Aspergillus was the most common in the lower respiratory tract,accounting for 76.8％.Among them,Aspergillus fumigatus accounted for the highest proportion(33.6％).98.6％of the molds infected the ear were Aspergillus,of which Aspergillus niger and Aspergillus terreus were the most common.Skin infections are mainly caused by Sporothrix schenckii,Trichophyton rubrum,Microsporum ca-nis.The results of in vitro drug sensitivity test showed that the four common Aspergillus isolated in this hos-pital were sensitive to voriconazole,and amphotericin B had better antifungal activity against Mucorales in vitro.Conclusion Based on the main epidemiological characteristics of fungal infections in this hospital,it is recommended that special attention be paid to the admission of patients in the respiratory department during the peak infection period in autumn and winter.In the treatment of fungal infections in different regions and on different body parts,attention should be paid to the differences in the distribution of bacterial species.

Objective:To explore the application of three-level task-driven teaching based on motivational regulation strategy in training nurse interns in the Department of Clinical Psychology.Methods:This study included 80 nurse interns in the Department of Clinical Psychology at Zhejiang Provincial People's Hospital between June 2021 and May 2024 as research subjects. They were divided into a control group ( n=40) and an experimental group ( n=40). The control group received traditional teaching, while the experimental group received three-level task-driven teaching based on motivational regulation strategy, covering basic knowledge mastery, practical operation improvement, and comprehensive ability enhancement. Through scenario guidance and simulation exercises, the intrinsic motivation of nurse interns was stimulated. The assessment scores, self-learning ability, teaching quality, and recognition of teaching were compared between the two groups of nurse interns. Results:After teaching, the experimental group scored higher than the control group on theoretical assessment [(86.05±5.86) vs. (74.35±4.72)] and operational skill assessment [(88.18±5.67) vs. (82.65±6.09)] ( P<0.001). The total score and scores of various dimensions of teaching quality were higher in the experimental group compared to those in the control group ( P<0.001). After teaching, the total score and scores of various dimensions of self-learning ability of both groups were higher than those before teaching, and the scores were higher in the experimental group than in the control group ( P<0.05). Conclusions:The three-level task-driven teaching based on motivational regulation strategy can significantly improve the assessment scores, self-learning abilities, and teaching quality of nurse interns in the Department of Clinical Psychology. Additionally, this method can enhance their recognition of nursing internship teaching. This teaching method is worth promoting.

Objective To investigate the effects of implant length,diameter,and abutment angle on bone stress distributions around maxillary central incisors,and determine the optimal parameter combination.Methods A three-dimensional(3D)model of the maxilla was reconstructed based on CBCT data.Using an orthogonal table,a total of 16 dental implant 3D models were established,varying in length,diameter,and abutment angle.These models were assembled with the maxillary and rigid-body models.Finite element analysis was performed using the transient dynamics module of ANSYS.Orthogonal experiments and one-way analysis of variance(ANOVA)were conducted on the obtained stress data.Results The implant diameter showed a statistically significant effect on the maximum von Mises stress in cortical bone(P=0.010),while implant length(P=0.229)and abutment angle(P=0.844)did not demonstrate a statistical significance.The optimal parameter combination for cortical bone stress was 5.0 mm implant diameter,12 mm implant length,and 0° abutment angle.In cancellous bone,implant length(P=0.001),diameter(P=0.011),and abutment angle(P=0.013)all had statistically significant effects on the maximum von Mises stress.The optimal parameter combination for cancellous bone stress was 14 mm implant length,5.0 mm implant diameter,and 5° abutment angle.Conclusions Implant diameter significantly affects the stress of both cortical and cancellous bone.Clinically,a larger diameter should be preferred to reduce the stress peak.Implant length is the next most important factor,while abutment angle has the least effect.

We report a case of a male patient who developed persistent fever and central nervous system symptoms after eating raw snails for 10 days. The patient was diagnosed with Angiostrongyliasis depended on the clinical presentation, epidemiological history, and etiological results. The patient recovered after receiving albendazole anthelmintic and dexamethasone anti-inflammatory therapy. This article incorporates literature review to sort out the diagnosis and treatment of this patient, in order to provide feasible reference for clinicians.

Objective To explore the feasibility and clinical outcome of lateral cervical incision via sternocleidomastoid intermuscular approach(SMIA)in the treatment of primary hyperparathyroidism.Methods The clinical data of 64 patients with primary hyperparathyroidism who underwent unilateral parathyroid surgery in the First Affiliated Hospital,School of Medicine of Zhejiang University from January 2019 to June 2022 were retrospectively analyzed.They were divided into lateral cervical incision via sternocleidomastoid intermuscular approach group(SMIA group)and linea alba cervicalis approach group(LACA group)based on the surgical incision and access route.The differences in clinical features,surgery-related outcomes and postoperative functions of the anterior cervical region were compared between the two groups.The EQ-5D-5L scale was used to assess the subjective feeling of postoperative neck discomfort,while the Hollander Wound Assessment Scale was used to assess the clinical outcome of incision healing.Results There were no statistical differences between the two groups of patients in terms of age,gender,intraoperative bleeding,parathyroid hormone or blood calcium levels before and after surgery(P＞0.05).The duration of surgery was significantly shorter in the SMIA group than in the LACA group[(39.77±5.69)min vs.(54.41±4.66)min].There was a statistical difference between the two groups in functional protection of the anterior cervical region at 1 month and 12 months after surgery(1 month,84.67±3.74 vs.79.47±5.38,P＜0.001;12 months,93.80±2.52 vs.89.94±2.39,P＜0.001),and the SMIA group was better than the LACA group.The Hollander Incision Assessment Scale scores of the SMIA group were better than those of the LACA group at 6 months and 12 months after surgery,and the difference was statistically significant(6 months,1.93±0.58 vs.2.41±0.66,P=0.003;12 months,1.03±0.67 vs.1.74±0.62,P＜0.001).Conclusion Parathyroidectomy via sternocleidomastoid intermuscular approach through lateral cervical incision is a simple,safe and effective surgical procedure,which makes it easier to search for parathyroid lesions and shortens the surgical time compared with the traditional incision,and has obvious advantages in the protection of anterior cervical region function.

We report a case of a male patient who developed persistent fever and central nervous system symptoms after eating raw snails for 10 days. The patient was diagnosed with Angiostrongyliasis depended on the clinical presentation, epidemiological history, and etiological results. The patient recovered after receiving albendazole anthelmintic and dexamethasone anti-inflammatory therapy. This article incorporates literature review to sort out the diagnosis and treatment of this patient, in order to provide feasible reference for clinicians.

Parkinson's disease (PD) is the most common neurodegenerative movement disease. It is featured by abnormal alpha-synuclein (α-syn) aggregation in dopaminergic neurons in the substantia nigra. Macroautophagy (autophagy) is an evolutionarily conserved cellular process for degradation of cellular contents, including protein aggregates, to maintain cellular homeostasis. Corynoxine B (Cory B), a natural alkaloid isolated from Uncaria rhynchophylla (Miq.) Jacks., has been reported to promote the clearance of α-syn in cell models by inducing autophagy. However, the molecular mechanism by which Cory B induces autophagy is not known, and the α-syn-lowering activity of Cory B has not been verified in animal models. Here, we report that Cory B enhanced the activity of Beclin 1/VPS34 complex and increased autophagy by promoting the interaction between Beclin 1 and HMGB1/2. Depletion of HMGB1/2 impaired Cory B-induced autophagy. We showed for the first time that, similar to HMGB1, HMGB2 is also required for autophagy and depletion of HMGB2 decreased autophagy levels and phosphatidylinositol 3-kinase III activity both under basal and stimulated conditions. By applying cellular thermal shift assay, surface plasmon resonance, and molecular docking, we confirmed that Cory B directly binds to HMGB1/2 near the C106 site. Furthermore, in vivo studies with a wild-type α-syn transgenic drosophila model of PD and an A53T α-syn transgenic mouse model of PD, Cory B enhanced autophagy, promoted α-syn clearance and improved behavioral abnormalities. Taken together, the results of this study reveal that Cory B enhances phosphatidylinositol 3-kinase III activity/autophagy by binding to HMGB1/2 and that this enhancement is neuroprotective against PD.