Objective:To explore the optimization potential of clinical target volume (CTV) delineation proposed in the guidelines of the Oncology Group (RTOG), the Francophone Group of Urological Radiotherapy (GFRU), and the European Society for Radiotherapy and Oncology (ESTRO) based on prostate bed local occurrence patterns after radical prostatectomy identified using prostate-specific membrane antigen positron emission tomography (PSMA PET).Methods:A retrospective analysis was conducted on patients with local prostate bed recurrence after radical prostatectomy who underwent PSMA PET at the Department of Nuclear Medicine, Peking University First Hospital from September 2021 to February 2024. The central point of each recurrence was marked. A six-zone method was established based on prostate bed anatomy and the characteristics of cross-sectional imaging. Then, the positional relationships (within or outside) were recorded with respect to recurrences and CTV defined by the RTOG, GFRU, and ESTRO (CTV RTOG, CTV GFRU, and CTV ESTRO), followed the analysis of the recurrence rates and distribution characteristics of various zones. Results:A total of 63 patients with prostate bed recurrence after radical prostatectomy were enrolled in this study, including 97 recurrences. The recurrence rates in the six zones were as follows: 10% of zone 1, 22% of zone 2, 29% of zone 3, 2% of zone 4, 12% of zone 5a, 18% of zone 5b, and 7% of zone 6. Among these zones, zones 2 and 3 showed the highest and second-highest recurrence rates, respectively. CTV GFRU and CTV ESTRO completely covered zones 2 and 3, while CTV RTOG covered zone 2 completely and zone 3 partially. Zone 4, characterized by a low recurrence rate, was not covered by CTV GFRU and CTV ESTRO but was entirely covered by CTV RTOG. Zone 5a, with a recurrence rate of 12%, was completely covered by CTV RTOG but was partially covered by CTV GFRU and CTV ESTRO. The range of 1.3 cm in front of the posterior wall of the bladder covered all recurrences in zone 5a. Conclusions:For CTV delineation of the prostate cancer surgical bed, zone 4, the anterior half of the bladder above the pubic symphysis midpoint, should be contracted due to the low recurrence rate in this zone. In contrast, the anterior boundary above the pubic symphysis midpoint should extend to 1.3 cm in front of the posterior wall of the bladder to completely cover the recurrence zones.

Objective:To explore the optimization potential of clinical target volume (CTV) delineation proposed in the guidelines of the Oncology Group (RTOG), the Francophone Group of Urological Radiotherapy (GFRU), and the European Society for Radiotherapy and Oncology (ESTRO) based on prostate bed local occurrence patterns after radical prostatectomy identified using prostate-specific membrane antigen positron emission tomography (PSMA PET).Methods:A retrospective analysis was conducted on patients with local prostate bed recurrence after radical prostatectomy who underwent PSMA PET at the Department of Nuclear Medicine, Peking University First Hospital from September 2021 to February 2024. The central point of each recurrence was marked. A six-zone method was established based on prostate bed anatomy and the characteristics of cross-sectional imaging. Then, the positional relationships (within or outside) were recorded with respect to recurrences and CTV defined by the RTOG, GFRU, and ESTRO (CTV RTOG, CTV GFRU, and CTV ESTRO), followed the analysis of the recurrence rates and distribution characteristics of various zones. Results:A total of 63 patients with prostate bed recurrence after radical prostatectomy were enrolled in this study, including 97 recurrences. The recurrence rates in the six zones were as follows: 10% of zone 1, 22% of zone 2, 29% of zone 3, 2% of zone 4, 12% of zone 5a, 18% of zone 5b, and 7% of zone 6. Among these zones, zones 2 and 3 showed the highest and second-highest recurrence rates, respectively. CTV GFRU and CTV ESTRO completely covered zones 2 and 3, while CTV RTOG covered zone 2 completely and zone 3 partially. Zone 4, characterized by a low recurrence rate, was not covered by CTV GFRU and CTV ESTRO but was entirely covered by CTV RTOG. Zone 5a, with a recurrence rate of 12%, was completely covered by CTV RTOG but was partially covered by CTV GFRU and CTV ESTRO. The range of 1.3 cm in front of the posterior wall of the bladder covered all recurrences in zone 5a. Conclusions:For CTV delineation of the prostate cancer surgical bed, zone 4, the anterior half of the bladder above the pubic symphysis midpoint, should be contracted due to the low recurrence rate in this zone. In contrast, the anterior boundary above the pubic symphysis midpoint should extend to 1.3 cm in front of the posterior wall of the bladder to completely cover the recurrence zones.

Purpose To investigate the expression of Versican(VCAN)and thrombospondin 2(THBS2)and their relationship with cancer-associated fibroblast(CAFs)and clinicopathological significance in papillary thyroid car-cinoma(PTC).Methods Bioinformatics analyses were performed using PTC single-cell sequencing data from the GEO and TCGA database.Weighted correlation network analysis identified CAFs-related genes,and enrichment analy-sis highlighted pivotal genes associated with CAFs;the expression of VCAN,THBS2,and α-SMA in 130 PTC tissue samples were detected by immunohistochemistry EnVision method.Masson staining evaluated tumor stromal fibrosis.Relationships between these markers,clinicopathological parameters,and CAF proliferation were analyzed.Results Bioinformatics analysis identified VCAN and THBS2 as core genes significantly associated with CAFs,and extracellular matrix-related pathways.The proliferation rate of CAFs in PTC was 83.1％(108/130),with positivity rate of 96.9％(126/130)for VCAN and 75.4％(98/130)for THBS2.The median mesenchymal fibrosis index was 32.4(inter-quartile range:22.7-50.0).High CAF proliferation correlated positively with lymph node metastasis(P＜0.001),higher TNM stage(P＜0.05),and specific histologic subtypes of PTC.Similarly,VCAN expression,THBS2 expres-sion,and the degree of PTC stromal fibrosis were positively correlated with lymph node metastasis(P＜0.001,P＜0.05,and P＜0.001,respectively).Both THBS2 expression and the degree of PTC stromal fibrosis correlated with the histologic subtype of PTC.The percentage of tumor mesenchymal α-SMA-positive cells strongly correlated with the im-mune response score(IRS)of VCAN and THBS2(rs=0.713,P＜0.001;rs=0.646,P＜0.001).Additionally,the percentage of Masson-stained area was positively correlated with the percentage of tumor mesenchymal α-SMA-posi-tive cells,and the IRS of VCAN and THBS2(rs=0.892,P＜0.001;rs=0.729,P＜0.001;rs=0.616,P＜0.001).Conclusion VCAN and THBS2 serve as potential markers for assessing invasiveness and lymph node metas-tasis of PTC.Their strong association with CAFs provides a basis for further investigation of the malignant biological be-havior of PTC.

Objective To develop a scientific,systematic,and operable healthcare quality evaluation system for Nation-al Regional Medical Centers(NRMCs),providing a theoretical basis and practical tool for objectively assessing their construction outcomes and guiding high-quality development.Methods Based on the classic"Structure-Process-Outcome"(SPO)quality management model,and aligned with national policy directives and the functional positioning of regional medical centers,a pre-liminary set of evaluation indicators was screened and an indicator system was constructed through literature review,policy analy-sis,and field investigations.Guangxi Hospital Division of The First Affiliated Hospital,Sun Yat-sen University was selected as the study subject,and cross-sectional data from March 2023 to June 2025 were collected for empirical application.Results A healthcare quality evaluation system for NRMCs was established,comprising 3 first-level dimensions(Structure Quality,Process Quality,Outcome Quality),10 second-level indicators,and 66 third-level indicators.This system covers multiple aspects,inclu-ding resource allocation,healthcare service efficiency,clinical practices,patient outcomes,and social benefits.Empirical results indicated that the center demonstrated a consistent upward trend in key indicators such as"Proportion of Discharged Patients Un-dergoing Level-4 Surgeries"(O1.2)and"DRG-CMI Value"(O2.1),while"Average Length of Hospital Stay"(P3.1)and"Cost Consumption Index"(O2.3)showed a steady decline.The indicator system effectively revealed the center's progress in en-hancing regional influence and operational efficiency.Conclusion The developed healthcare quality evaluation system is well-grounded in theory and practice,combining scientific rigor with policy relevance,and can serve as a decision-support tool for quality assessment and improvement in National Regional Medical Centers.

Objective To develop a scientific,systematic,and operable healthcare quality evaluation system for Nation-al Regional Medical Centers(NRMCs),providing a theoretical basis and practical tool for objectively assessing their construction outcomes and guiding high-quality development.Methods Based on the classic"Structure-Process-Outcome"(SPO)quality management model,and aligned with national policy directives and the functional positioning of regional medical centers,a pre-liminary set of evaluation indicators was screened and an indicator system was constructed through literature review,policy analy-sis,and field investigations.Guangxi Hospital Division of The First Affiliated Hospital,Sun Yat-sen University was selected as the study subject,and cross-sectional data from March 2023 to June 2025 were collected for empirical application.Results A healthcare quality evaluation system for NRMCs was established,comprising 3 first-level dimensions(Structure Quality,Process Quality,Outcome Quality),10 second-level indicators,and 66 third-level indicators.This system covers multiple aspects,inclu-ding resource allocation,healthcare service efficiency,clinical practices,patient outcomes,and social benefits.Empirical results indicated that the center demonstrated a consistent upward trend in key indicators such as"Proportion of Discharged Patients Un-dergoing Level-4 Surgeries"(O1.2)and"DRG-CMI Value"(O2.1),while"Average Length of Hospital Stay"(P3.1)and"Cost Consumption Index"(O2.3)showed a steady decline.The indicator system effectively revealed the center's progress in en-hancing regional influence and operational efficiency.Conclusion The developed healthcare quality evaluation system is well-grounded in theory and practice,combining scientific rigor with policy relevance,and can serve as a decision-support tool for quality assessment and improvement in National Regional Medical Centers.

Purpose To investigate the expression of Versican(VCAN)and thrombospondin 2(THBS2)and their relationship with cancer-associated fibroblast(CAFs)and clinicopathological significance in papillary thyroid car-cinoma(PTC).Methods Bioinformatics analyses were performed using PTC single-cell sequencing data from the GEO and TCGA database.Weighted correlation network analysis identified CAFs-related genes,and enrichment analy-sis highlighted pivotal genes associated with CAFs;the expression of VCAN,THBS2,and α-SMA in 130 PTC tissue samples were detected by immunohistochemistry EnVision method.Masson staining evaluated tumor stromal fibrosis.Relationships between these markers,clinicopathological parameters,and CAF proliferation were analyzed.Results Bioinformatics analysis identified VCAN and THBS2 as core genes significantly associated with CAFs,and extracellular matrix-related pathways.The proliferation rate of CAFs in PTC was 83.1％(108/130),with positivity rate of 96.9％(126/130)for VCAN and 75.4％(98/130)for THBS2.The median mesenchymal fibrosis index was 32.4(inter-quartile range:22.7-50.0).High CAF proliferation correlated positively with lymph node metastasis(P＜0.001),higher TNM stage(P＜0.05),and specific histologic subtypes of PTC.Similarly,VCAN expression,THBS2 expres-sion,and the degree of PTC stromal fibrosis were positively correlated with lymph node metastasis(P＜0.001,P＜0.05,and P＜0.001,respectively).Both THBS2 expression and the degree of PTC stromal fibrosis correlated with the histologic subtype of PTC.The percentage of tumor mesenchymal α-SMA-positive cells strongly correlated with the im-mune response score(IRS)of VCAN and THBS2(rs=0.713,P＜0.001;rs=0.646,P＜0.001).Additionally,the percentage of Masson-stained area was positively correlated with the percentage of tumor mesenchymal α-SMA-posi-tive cells,and the IRS of VCAN and THBS2(rs=0.892,P＜0.001;rs=0.729,P＜0.001;rs=0.616,P＜0.001).Conclusion VCAN and THBS2 serve as potential markers for assessing invasiveness and lymph node metas-tasis of PTC.Their strong association with CAFs provides a basis for further investigation of the malignant biological be-havior of PTC.

Examining mechanisms involved in the mutual regulation between the muscular system and the skeletal system, elucidating the key issues responsible for loss of muscle and bone mass and strength, and thus halting the progression of these conditions are critical measures for reducing fractures caused by falls and subsequent disability and mortality.At present, most studies have treated the muscular system and the skeletal system separately, often ignoring the mutual regulation and connections between them.This article reviews the current research progress on the mechanisms of interaction between the two systems, aiming to provide a basis for the prevention, diagnosis and treatment of disuse-related diseases in the elderly population.

Objective:To explore the optimal index of rotational displacement of femoral neck fractures by modeling the axial rotational displacement of femoral neck fractures after reduction and based on X-ray projections.Methods:Six dry human femur specimens, comprising 2 males and 4 females, were utilized in the study. Design and manufacture a proximal femur ortholateral and oblique X-ray casting jigs and mounts. The femoral neck fracture was modeled on the femoral specimen, with Pauwells 30°, 50°, and 70° models (2 each) made according to Pauwells typing. The fractures were manually repositioned with residual anterior 20°, 40° and 60° axial rotational displacements. Each fracture model was projected at different angles (pedicled 40°, pedicled 20°, vertical 0°, cephalad 20°, and cephalad 40°), and the trabecular angle and Garden's alignment index of the model were measured to observe the imaging characteristics of the fracture line on the medial oblique and lateral oblique radiographs.Results:In the presence of a 20° and 40° anterior rotational displacement following reduction of a femoral neck fracture, the trabecular angle in the rotationally displaced group was not significantly different from that of the anatomically repositioned group in various projection positions. However, when a residual rotational displacement of 60° was present, the trabeculae appeared blurred at most projection angles in the Pauwells 30° and 50° models, failing to measure trabecular angles. In the Pauwells 70° fracture model, the trabecular angle in the rotational displacement group was significantly different from that in the anatomical reduction group. In anteroposterior radiographs, when the anterior rotation displacement was 60° in the Pauwells 70° group, Garden's contralateral index showed an unsatisfactory restoration (150°, 142°), whereas all rotationally displaced models in the Pauwells 30° and Pauwells 50° groups had a Garden's contralateral index of >155°, which achieved an acceptable restoration. In lateral radiographs, all rotational displacement models with Garden's alignment index>180° failed to achieve acceptable repositioning, and the larger the Pauwells angle the greater the Garden's alignment index at the same rotational displacement. In the internal oblique position with a bias towards the foot side, the image showed partial overlap between the femoral head and the shaft, making it difficult to assess the quality of the reduction. Conversely, when projected cephalad, the femoral neck appeared longer, particularly at a projection angle of 40° cephalad, allowing for clear observation of the fracture line and the anatomy of the proximal femur. The trabeculae were not well visualized in the external oblique position.Conclusion:There are limitations in applying the trabecular angle to assess the axial rotational displacement of the femoral head after reduction of femoral neck fractures. The Pauwells 70° with residual rotational anterior displacement of 60° was the only way to detect axial rotational displacement of the femoral head on anteroposterior radiographs Garden's alignment index. For the determination of axial rotational displacement of the femoral head, the Garden's alignment index on lateral radiographs provides higher reliability.

Objective:To establish a scientific and standardized routine for perioperative nursing in pediatric otolaryngology, reduce the incidence of postoperative delirium, and improve the quality of postoperative recovery by implementing the best practice of evaluation and intervention of postoperative delirium in pediatric otolaryngology.Methods:By reviewing literature related to evaluation, prevention, intervention and management of postoperative delirium in pediatric otolaryngology from March 2018 to September 2019, fourteen best practice were concluded. By combining the best evidence and the clinical circumstances, the evidenced-based criteria were established and then applied in the Otolaryngology and Head and Neck Surgery Department, the Children ′s Hospital of Zhejiang University School of Medicine. Results:After three rounds of reviews, the results showed that the criteria 2, 3, 6, and 8 had 100.0% complacence. Comparison of before and after applying the evidence, there was no statistically significant difference for the occurrence of postoperative delirium or pain ( P>0.05); there was a statistically significant reduction of pain score at 60 minutes after returning to the ward ( χ2=9.93, P<0.05); there was a statistically significant reduction of preoperative anxiety score of children ′s family members from (33.36 ± 6.84) points to (29.54 ± 6.94) points ( F=6.33, P<0.05); there was a statistically significant increase of doctors ′ score of delirium knowledge based on evidence from (23.00 ± 3.94) points to (33.43 ± 8.25) points ( t=-3.02, P<0.05); and there was a statistically significant increase of nurses ′ score of delirium knowledge based on evidence from (33.11 ± 8.46) points to (57.79 ± 6.58) points ( t=-10.35, P<0.05) when the evidence was applied. Conclusion:The evidence-based practice didn ′t significantly relieve the postoperative delirium in pediatric otolaryngology, but it was helpful to relieve the postoperative pain level of children and the anxiety level of their families. The management of postoperative delirium in pediatric otolaryngology needs to be further explored.

Objective:To retrieve, evaluate and integrate relevant evidence on the management of the developmentally supportive environment in the neonatal intensive care unit(NICU), and to provide clinical references.Methods:Evidence on NICU environmental management was retrieved from Guidelines International Network, Joanna Briggs Institute, National Institute for Health and Care Excellence, Scottish Intercollegiate Guide Network, National Guideline Clearinghouse, Registered Nurses′ Association of Ontario, Yimaitong and other Websites, BMJ Best Practice, UpToDate, Cochrane Library, PubMed, Embase, Wanfang Database, CNKI and other database.The evidence included guidelines, evidence summaries, best clinical practice manuals, expert consensus and systematic reviews.The date limit was from the establishment of the databases to March 31, 2021.Results:Totally 16 articles were involved, including 4 guidelines, 9 systematic reviews, and 3 expert consensus.Finally, 20 pieces of best evidence on four aspects were su-mmarized: sound, light, touch, and smell.There were 11 A-level recommendations and 9 B-level recommendations.The evidence suggested that health care workers should reduce noise and protect premature infants from being exposed to bright light, noxious gases, and negative touch stimuli.Besides, benign auditory and olfactory stimuli, circadian light, and mother-infant skin-to-skin contact should be used to promote the development of premature infants.Conclusions:This study is a summary of the recommendations on NICU environmental management.It is well-designed and has achieved fruitful results, showing great significance for reducing environmental stress of premature infants in the NICU.However, the current recommended methods for providing benign stimulation require validation of more high-quality, well-designed research.It is recommended that medical staff should selectively apply the evidence to clinical practice according to the actual situation.