Objective To track and evaluate the implementation and application of the occupational health standard Radiation shielding requirements for radiotherapy room—Part 4: Radiotherapy room of ²⁵²Cf neutron afterloading (GBZ/T 201.4-2015) by radiation health technical service agencies, medical institutions, health supervision agencies, and radiotherapy facility design units, and to provide a scientific basis for the further revision and implementation of this standard. Methods Following the Guideline for health standards tracking evaluation (WS/T 536-2017) and the project implementation plan, relevant practitioners were randomly selected for a questionnaire survey. The survey primarily focused on their awareness, standard training, application, and revision suggestions of GBZ/T 201.4-2015. The results were summarized and analyzed. Results A total of 168 evaluation questionnaires were collected from relevant practitioners in 28 provinces. Only 31.6% of the respondents reported being “well familiar” or “ familiar” with the standard, 27.4% of the respondents believed that the standard was widely used, and 45.2% of the respondents believed that the standard could meet the needs of their work. Only 14.9% of the respondents had received relevant training on the standard, more than half of the respondents had not applied the standard within the past 10 years, and 45.2% of the respondents believed that the standard "needs to be revised". Conclusion Due to the small number of californium-252 neutron afterloading radiotherapy devices in operation on the market, the overall awareness of the standard is low, suggesting that relevant authorities need to strengthen training and publicity of the standard, and that certain sections of the standard need to be revised or merged.

To develop a milestone-based evaluation system for the core "knowledge and skills" competency of neurology residents that is tailored to China's medical context, so as to provide precise guidance for their training and assessment.

Objective:To systematically integrate the qualitative research on effective pain management disorders of cancer patients and caregivers, and to provide reference for patients and caregivers to safely and effectively implement cancer pain management.Methods:The qualitative studies on the experiences and obstacles of cancer patients and caregivers in cancer pain management were retrieved from electronic databases of PubMed, Web of Science, Cochrane Library, Embase, CINAHL, China National Knowledge Infrastructure, China Biology Medicine, VIP and Wanfang data from inception to September 2023. The quality of the literature was evaluated according to Joanna Briggs Institute Evidence Based Healthcare Center Critical Appraisal Tool for qualitative studies in Australia. Meta-synthesis was used to conduct the synthesis.Results:A total of 9 articles were included, and 46 research results were extracted, forming 14 categories, which were further summarized into 4 integrated results: patient-related pain management disorders, caregiver-related pain management disorders, medical staff-related pain management disorders, and health care system-related pain management disorders.Conclusions:Multiple factors cause obstacles for cancer patients and caregivers to participate in pain management. Medical staff should have a deep understanding of patients′pain problems and explore pain management plans and interventions suitable for cancer patients, so as to reduce the degree of cancer pain management obstacles.

Objective:To investigate the effect of mitochondrial division of GABAergic neurons in substantia nigra pars reticulata(SNr)on motor dysfunction in mice with acute hepatic encephalopathy(AHE).Methods:AHE mice model was established by intraperitoneal injection of thioacetamide(TAA).The changes of liver lobules in AHE mice were observed by hematoxylin-eosin(HE)staining.The changes of serum aspartate aminotransferase(AST),alanine aminotransferase(ALT)and blood ammonia in AHE mice were detected by biochemical detection kit.Then,the motor function of AHE mice was observed by rod fatigue test,elevated cross maze test and open field test.Furthermore,the changes of mitochondrial area,perimeter,roundness and other morphological indicators in SNr of AHE mice were ob-served and analyzed by transmission electron microscopy.The expression of mitochondrial division and fusion related molecules in SNr of AHE mice was observed by Western Blot.Then,the expression of mitochondrial dynamic related protein 1(DRP1)in SNr of AHE mice was targeted by AAV virus.The mitochondrial membrane potential(MMP),ATP and reactive oxygen species(ROS)in SNr were detected by fluorescence enzyme marker,and the changes of motor function of mice were observed.Results:Compared with the control group,the motor function of AHE mice was signifi-cantly decreased,the mitochondrial division of SNr was significantly enhanced,and the expression of mitochondrial divi-sion related proteins was significantly increased.The MMP in SNr of AHE mice was significantly decreased,the ATP of cells was decreased,and the ROS was increased.After targeted inhibition of DRP1 expression in SNr of AHE mice,the movement was improved;further observation found that after the mitochondrial division in SNr of AHE mice was inhibi-ted,the MMP was significantly increased,the ATP of cells was increased,and the ROS was decreased,which demon-strated that the mitochondrial function was significantly improved.Conclusion:Targeted inhibition of mitochondrial di-vision of GABAergic neurons in SNr of AHE mice can improve mitochondrial morphology and function,thus alleviating their movement disorders.

Objective　: To verify the feasibility of using a homemade lung phantom for quality control of Cyberknife by comparing the measurement results of the homemade lung phantom and CIRS dynamic phantom in E2E testing of Cyberknife lung tracking.  Methods　 : The patient treatment process was simulated, including CT positioning, plan design, irra- diation implementation, film scanning, and analysis using the homemade phantom and CIRS phantom. The two phantoms were measured five times using MLC under the S7 generation Cyberknife and five times using Iris under the M6 generation Cyberknife. The differences in measurement results between the two phantoms were analyzed using independent sample t-test. Results　: For the S7 generation Cyberknife, the statistical analysis of differences between the two phantoms in the detection values on the X-axis, Y-axis, Z-axis, and total deviation showed P values of 0.236, 0.175, 0.289, and 0.668, respect- ively. For the M6 generation Cyberknife, the statistical analysis showed P values of 0.880, 0.891, 0.573, and 0.433, respect- ively. The P values were all > 0.05. Therefore, there were no statistically significant differences in the detection results between the homemade lung phantom and the CIRS phantom under the S7 and M6 generation Cyberknife. The total deviation values were <1.5 mm. Conclusion　 The homemade lung phantom and CIRS phantom have consistent measurement results in the E2E testing of Cyberknife lung tracking and meet the requirements of Report of AAPM TG-135 and WS 667- 2019 standard. Therefore, the homemade lung phantom is feasible for clinical quality control of Cyberknife.

Objectives:This study aims to investigate optimal surgical management strategies for pediatric patients diagnosed with volume-overloaded mitral regurgitation. Methods:A comprehensive retrospective analysis was conducted on a cohort of 110 pediatric patients who underwent primary mitral valve repair for volume-overloaded mitral regurgitation at Fuwai Hospital between April 2020 and March 2022.The cohort,with an average age of(14.5±15.1)months and 38.2%males,was divided into standardized group for patients receiving 3-step standardized mitral valvuloplasty(n=69)and annuloplasty group for patients undergoing annuloplasty only(n=41).After propensity score matching,a total of 38 pairs of patients were included,comparing the primary endpoint(functional mitral failure and postoperative heart failure)between the two groups. Results:Over a median follow-up of 26.3(19.8,32.9)months,and with a median echocardiographic follow-up of 11.9(7.5,14.8)months,no death was recorded.Among the cases,one patient(0.8%)necessitated unplanned reoperation;and seven patients(6.4%)experienced a recurrence of moderate-severe mitral regurgitation as observed through echocardiography beyond 6 months post-surgery.Additionally,nine patients developed heart failure at one month post-discharge.Above events were similar between the two groups.Following propensity score matching,patients in the standardized group demonstrated significantly longer cardiopulmonary bypass and aortic cross-clamp times compared to the annuloplasty group(both P＜0.05),other outcomes were similar between the two groups.Subgroup analysis based on age indicated that infants(＜1 year old)in the standardized group exhibited a significantly lower incidence of major endpoint events compared to the annuloplasty group.Additionally,postoperative echocardiography in annuloplasty group indicated that Z score of left ventricular end diastolic diameter was still greater than 2 during the latest follow-up. Conclusions:Patients with volume-overloaded mitral regurgitation in the standardized group exhibited comparable perioperative recovery and postoperative outcomes as in the annuloplasty group.For pediatric patients suffering from volume-overloaded mitral regurgitation,particularly those under one year of age,the standardized surgical approach exhibited reduced rates of heart failure and major endpoint events,and this strategy is more suitable for this patient group.

Objective:To investigate the effect of N-acetylserotonin (NAS) on the retinal microglia polarization in retinal ischemia-reperfusion injury (RIRI) rats and explore its mechanism via nucleotide-bound oligomeric domain 1 (NOD1)/receptor interacting protein 2 (Rip2) pathway.Methods:Healthy male Sprague Dawley rats were randomly divided into Sham ( n=21), RIRI ( n=21) and NAS (injected intraperitoneally 30 min before and after modeling with NAS, 10 mg/kg, n=18) groups, using random number table. And the right eye was used experimental eye. The RIRI model of rats in RIRI group and NAS group was established by anterior chamber high intraocular pressure method. Rats in NAS group were intraperitoneally injected with 10 mg/kg NAS before and 30 min after modeling, respectively. The retinal morphology and the number of retinal ganglion cell (RGC) in each group were detected by hematoxylin-eosin staining and immunohistochemical staining. The effect of NAS on polarization of retinal microglia was detected by immunofluorescence staining. Transcriptome sequencing technology was used to screen out the differentially expressed genes between Sham and RIRI groups. Western blot and real-time quantitative polymerase chain reaction (RT-PCR) were used to examine the differentially expressed genes. Immunohistochemical staining, Western blot and RT-PCR were used to investigate the effect of NAS on the expression of NOD1 and Rip2 protein and mRNA in retinal tissue and microglia of rats. General linear regression analysis was performed to determine the correlation between the number difference of NOD1 + cells and the number difference of M1 and M2 microglia in retinal tissues of rats in NAS group and RIRI group. Results:A large number of RGC were observed in the retina of rats in Sham group. 24 h after modeling, compared with Sham group, the inner retinal thickness of rats in RIRI group was significantly increased and the number of RGC was significantly decreased. The thickness of inner retina in NAS group was significantly thinner and the number of RGC was significantly increased. Compared with Sham group, the number of retinal microglia of M1 and M2 in RIRI group was significantly increased. Compared with RIRI group, the number of M1 microglia decreased significantly and the number of M2 microglia increased significantly in NAS group. There was statistical significance in the number of M1 and M2 microglia in the retina of the three groups ( P<0.05). Transcriptome sequencing results showed that retinal NOD1 and Rip2 were important differential genes 24 h after modeling. The mRNA and protein relative expressions of NOD1 and Rip2 in retina of RIRI group were significantly higher than those of Sham group, with statistical significance ( P<0.05). The number of NOD1 + and Rip2 + cells and the relative expression of mRNA and protein in retinal microglia in RIRI group were significantly higher than those in Sham group, and NAS group was also significantly higher than that in Sham group, but lower than that in RIRI group, with statistical significance ( P<0.05). The number of Iba-1 +/NOD1 + and Iba-1 +/Rip2 + cells in retinal microglia in RIRI group was significantly increased compared with that in Sham group, and the number of Iba-1 +/Rip2 + cells in NAS group was significantly decreased compared with that in RIRI group, but still significantly higher than that in Sham group, with statistical significance ( P<0.05). Correlation analysis results showed that the difference of retinal NOD1 + and Rip2 + cells in NAS group and RIRI group was positively correlated with that of M1 microglia ( r=0.851, 0.895), and negatively correlated with that of M2 microglia ( r=-0.797, -0.819). The differences were statistically significant ( P<0.05). Conclusion:NAS can regulate the microglial polarization from M1 to M2 phenotype, the mechanism is correlated with the NOD1/Rip2 pathway.

Two pediatric heart failure patients were treated with pulmonary artery banding(PAB)at Fuwai Hospital,from December 2021 to January 2022.In the first case,an 8-month-old patient presented with left ventricular non-compaction cardiomyopathy(LVNC),left ventricular systolic dysfunction,ventricular septal defect,and atrial septal defect.The second case was a 4-month-old patient with LVNC,left ventricular systolic dysfunction,and coarctation of the aorta.After PAB,the left ventricular function and shape of both patients were significantly improved,without serious surgery-related complications.In these individual cases of pediatric heart failure,pulmonary artery banding exhibited a more satisfactory efficacy and safety compared to pharmacological treatment,especially for those with unsatisfactory medication results.Future clinical data are needed to promote the rational and broader application of this therapeutic option for indicated patients.

Electronic Health Records (EHRs) are digital health tools that support comprehensive care and digital services. This paper provides an overview of EHRs, summarizes their current applications in palliative care, and proposes solutions to address issues in the use of EHRs in this field. The aim is to offer reference points for promoting the application of EHRs in palliative care in China.

Objective:To explore indicators related to visceral fat index by constructing a random forest model.Methods:In this cross-sectional study, the laboratory measures and body composition analysis records of 617 hospital employees (in-service and retired) who underwent physical examination in Heilongjiang Provincial Hospital Health Management Center from March to September 2021 were selected. The subjects were divided into a training set ( n=411) and a test set ( n=206) with the ratio of 2∶1. A total of 110 predictors were included in the model. The model was constructed with the training set and was evaluated with the test set. The optimal number of nodes and decision trees were selected to evaluate the prediction performance of the optimal model. And the top 10 relatively important factors were selected for further investigation. The 617 participants were further divided in to groups according to the visceral fat index: the normal or high visceral fat index group, and the differences of the top 10 relatively important factors were further compared between the two groups. Results:The optimal number of nodes of the final random forest model was 39 and the number of decision trees was 300. The accuracy, precision, sensitivity and specificity of the model was 83.3%, 73.9%, 89.4% and 78.7%, respectively. The area under the receiver operating characteristic curve and 95% confidence interval of the model was 0.881 (0.832-0.931). The top 10 relatively important factors in the model were body mass index, gender, age, serum uric acid, red blood cell count, monocyte cell count, C-peptide, carcinoembryonic antigen, glycosylated hemoglobin and glutamyl transpeptidase. There were significant differences in the up-mentioned 10 indicators between the subjects with normal and high visceral fat index (all P<0.05). Conclusions:The random forest model built in this study has good performance in predicting visceral fat index, and visceral fat is related with changes in liver function, pancreas function and immune function.