Objective To explore the efficiency improvement in segmenting neural network with the application of Transformer + U-Net artificial intelligence (AI) and modeling with the application of Python scripts in three-dimensional (3D) printing brachytherapy. Methods A Transformer + U-Net AI neural network model was constructed, and Adam optimizer was used to ensure rapid gradient descent. Computed tomography or magnetic resonance imaging data of patients were standardized and processed as self-made data sets. The training set was used to train AI and the optimal result weight parameters were saved. The test set was used to evaluate the AI ability. Python programming language was used to write an automated script to obtain the output segmentation image and convert it to the STL file for import. The source applicator and needle could be automatically modeled. The time of automatic segmentation and modeling and the time of manual segmentation and modeling were entered by two people, and the difference was verified by paired t-test. Results Dice similarity coefficient (DSC), mean intersection over union (MIOU), and Hausdorff distance (HD95) were used for evaluation. DSC was 0.9341, MIOU was 0.8762, and mean HD95 was 2.516. The mean time of manual segmentation was 1187 s, and the mean time of AI segmentation was 145 s (P < 0.01). The mean time of manual modeling was 321 s, and the mean time of modeling with Python automated scripts was 18 s (P < 0.01). Conclusion The application of Transformer + U-Net automatic segmentation and Python automated scripts can effectively improve work efficiency in the 3D printing brachytherapy for cervical cancer.

[This corrects the article DOI: 10.1016/j.apsb.2019.01.013.].

Azvudine and nirmatrelvir/ritonavir (Paxlovid) are recommended for COVID-19 treatment in China, but their safety and efficacy in the elderly population are not fully known. In this multicenter, retrospective, cohort study, we identified 5131 elderly hospitalized COVID-19 patients from 32,864 COVID-19 patients admitted to nine hospitals in Henan Province, China, from December 5, 2022, to January 31, 2023. The primary outcome was all-cause death, and the secondary outcome was composite disease progression. Propensity score matching (PSM) was performed to control for confounding factors, including demographics, vaccination status, comorbidities, and laboratory tests. After 2:1 PSM, 1786 elderly patients receiving azvudine and 893 elderly patients receiving Paxlovid were included. Kaplan-Meier and Cox regression analyses revealed that compared with Paxlovid group, azvudine could significantly reduce the risk of all-cause death (log-rank P = 0.002; HR: 0.71, 95% CI: 0.573-0.883, P = 0.002), but there was no difference in composite disease progression (log-rank P = 0.52; HR: 1.05, 95% CI: 0.877-1.260, P = 0.588). Four sensitivity analyses verified the robustness of above results. Subgroup analysis suggested that a greater benefit of azvudine over Paxlovid was observed in elderly patients with primary malignant tumors (P for interaction = 0.005, HR: 0.32, 95% CI: 0.18-0.57) compared to patients without primary malignant tumors. Safety analysis revealed that azvudine treatment had a lower incidence of adverse events and higher lymphocyte levels than Paxlovid treatment. In conclusion, azvudine treatment is not inferior to Paxlovid treatment in terms of all-cause death, composite disease progression and adverse events in elderly hospitalized COVID-19 patients.

Human respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in infants and young children, as well as an important cause of respiratory tract infections in immunocompromised patients and the elderly, which poses a significant economic and social burden worldwide. In recent years, substantial progress has been made in understanding the structure and function of RSV proteins and the interactions between RSV with host factors which is helpful to the discovery of new therapeutic targets and the development of novel interventions. Although two vaccines and two monoclonal antibodies for RSV prevention have been approved, the antiviral treatment remains an unmet clinical need. In this review, we summarize the structure, protein functional properties, and pathological mechanisms of RSV and the current status of RSV drug development. In addition, remaining challenges and innovative ideas for RSV prevention and treatment have also been highlighted.

Sacroiliac complex injuries are commonly seen in high-energy pelvic fractures. The injuries make a big difference in treatment patterns due to the diverse injury types, posing considerable challenges in formulating optimal treatment strategies, and hence are persistent clinical difficulties in orthopedic trauma. The clinical management of sacroiliac complex injuries presents several key challenges such as a non-negligible rate of missed diagnoses in associated vascular and visceral injuries, absence of standardized protocols for surgical approaches and reduction-fixation strategies across different injury patterns, and ongoing controversies regarding surgical indications and optimal timing for patients combined with concomitant lumbosacral plexus injuries. Currently, no systematic clinical guidelines are available for the diagnosis and treatment of sacroiliac complex injuries both domestically and internationally. To this end, the Pelvic and Acetabular Surgery Group, Orthopedic Branch, China International Exchange and Promotive Association for Medical and Health Care and Orthopedic Physician Branch, Chinese Medical Doctor Association organized a panel of domestic experts in the field to develop the Clinical guideline for the diagnosis and treatment of sacroiliac complex injuries ( version 2025), based on evidence-based medicine and adhering to the principles of scientific rigor, clinical applicability, and innovation. These guidelines provided 11 recommendations covering diagnosis, therapeutic principles and techniques, management protocols for lumbosacral plexus injuries, outcome evaluation, and postoperative rehabilitation pathways, etc., aiming to standardize the clinical management of sacroiliac complex injuries.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease with a high mortality rate. Many countries worldwide have already reported local transmission, and the number of reported cases has been increasing yearly, with an ever-expanding region. No specific treatment drugs or vaccines have seriously threatened public health safety in epidemic regions. This article reviews the epidemiological characteristics, transmission routes, and control measures of SFTS.

Objective:To understand the pathogenic composition and epidemiological characteristics of febrile respiratory syndrome (FRS) in elderly people aged 60 and above in China, and to provide a reference basis for the scientific and precise prevention and control of FRS in the elderly.Methods:Based on FRS cases surveillance data from information management system of National Technical Platform for Infectious Disease Surveillance, National Science and Technology Major Project of China, the surveillance pathogens included 8 viruses, including influenza virus (IFV), respiratory syncytial virus (RSV), adenovirus (HAdV), parainfluenza virus (HPIV), metapneumovirus (HMPV), coronavirus (HCoV), bocavirus and rhinovirus (HRV); 7 bacterias, namely Streptococcus pneumoniae ( S.pneumoniae), Staphylococcus aureus ( S.aureus), Klebsiella pneumoniae ( K.pneumoniae), Pseudomonas aeruginosa ( P.aeruginosa), Group A Streptococcus ( GAS), Haemophilus influenzae ( H.influenzae) and Legionella pneumophila ( L. pneumophila), in addition to Chlamydia pneumoniae ( C. pneumoniae) and Mycoplasma pneumoniae ( M. pneumoniae). A descriptive epidemiological approach was used to analyze the pathogenic composition and major epidemiological characteristics of FRS cases aged 60 years and older nationwide from 2009 to 2021. Results:The predominant viruses of FRS cases aged≥60 years accounted for 87.93% of the pathogen spectrum in China, including IFV (42.42%), HRV (16.71%), HPIV (11.53%), HCoV (9.52%), and RSV (7.75%), while the pathogen spectrum of the major bacteria accounted for 94.60%, including S. pneumoniae (25.71%), P. aeruginosa (24.97%), K. pneumoniae (22.47%), H. influenzae (12.23%), and S. aureus (9.22%). Influenza viruses have always been at the top of the viral pathogen spectrum, and P. aeruginosa, K. pneumoniae and S. pneumoniae, ranked high in the bacterial pathogen spectrum. Among them, the proportions of HRV, HPIV, RSV, K. pneumoniae, and H. influenzae fluctuated and increased during the 13 years of observation. The positive rate of any pathogen in FRS cases was higher in out patient emergencies (32.83%) than in hospitalized cases (27.26%) ( χ2 =125.89, P<0.001). The positive rate of IFV was higher in cases aged 60-74 years (13.66%). The positive rate of P. aeruginosa and K. pneumoniae were higher in cases aged ≥90 years (10.71%, 9.40%) and in northern regions (8.32%, 7.30%). The positive rate of any pathogen in FRS cases was higher in winter (33.82%) than in other seasons ( χ2=212.03, P<0.001). The positive rate of IFV and HRV were higher in winter (22.87%) and autumn (5.98%) and the positive rate of P.aeruginosa (8.11%) and K.pneumoniae (8.30%) were higher in summer. Conclusions:IFV, HRV, HPIV, S. pneumoniae, P. aeruginosa and K. pneumoniae were respectively the top three pathogens in the viral and bacterial pathogen spectrum of FRS cases aged 60 years and above in China from 2009 to 2021, and the positive rate of these main pathogens showed differences between age groups, seasons, and geographic regions. In the future, the dynamic surveillance of various pathogens in the elderly with respiratory tract infections should be continuously strengthened.

Objective:To analyze the epidemiological characteristics and natural focus distribution of marburg virus disease (MVD), and provide evidence for the prevention and control of MVD.Methods:A systematic literature retrieval was conducted, and descriptive epidemiological method was used to analyze the temporal, spatial, and population distributions of MVD as well as its natural hosts. The case fatality rate of MVD was evaluated through Meta-analysis, and the phylogenetic analysis of viral genomes was done by using software IQ-TREE 2.3.6.Results:Marburg virus has endemic spread in Africa and can be detected in various animals such as primates and bats. The positive rate is higher in Egyptian fruit bats, and the disease epidemic areas continue to expand. The human infections occur frequently. As of December 20, 2024, a total of 18 MVD outbreaks had been reported worldwide, resulting in 722 reported cases and 548 deaths. Meta- analysis showed a case fatality rate of about 65.19% (95% CI: 48.07%-80.50%). Populations are generally susceptible, with a higher proportion of the cases in miners and medical workers. Marburg virus specific antibody can be detected in populations and animals in some countries and regions where no cases have been reported in Africa, indicating the potential of virus transmission. Conclusion:The transmission capacity of Marburg virus shows no significant changes, but the areas affected by the virus transmission expands, indicating increased risk for MVD outbreak.

Objective To investigate the impact of different application methods of tissue compensators(bolus)on the skin dose delivered to the chest wall following radical mastectomy for breast cancer.Methods A retrospective analysis was conducted on 60 female patients who underwent radical mastectomy and required chest wall radiotherapy at the hospital between January 2023 and March 2025.The Pinnacle3 9.10 radiotherapy planning system(TPS)was utilized to design two VMAT dual semi-arc radiotherapy plans for each patient,with a prescribed target dose of 50 Gy delivered in 2 Gy fractions over 25 sessions.In Plan 1,a Bolus was applied and optimized during the first 15 fractions,and subsequently removed for the remaining 10 fractions without re-optimization.The sub-field configuration and dose weighting from the initial optimization were retained,and only dose recalculations were performed.The final treatment plan combined both the Bolus-included and Bolus-excluded phases.In contrast,Plan 2 involved the application and optimization of Bolus during the first 15 fractions,followed by its removal and re-optimization of the plan for the last 10 fractions.The two optimized plans were then combined for the overall treatment delivery.Data from the two plan groups were analyzed using a paired sample t-test with SPSS 29.0 software.Results There was a statistically significant difference(P＜0.05)in skin Dmean,V52.5,and V55;heart Dmean,V5,V30,and V40;affected lung Dmean,V5,and V20;PRVcord Dmean and Dmax;healthy breast Dmean,V5,and V10;affected humeral head Dmean and V30;as well as PTV Dmean,V50,V55,D2％,D98％,CI,and MU.Moreover,the dose distribution on the target layer and the DVH curves showed marked differences.However,no statistically significant difference was observed in PTV HI(P=0.125).Conclusion The combination of the two optimized plans,consisting of 15 fractions with bolus and 10 fractions without bolus,more accurately reflects the dose distri-bution within the planned target area and organs at risk,thereby providing enhanced protection for the patient's chest wall skin.

Objective:To investigate the effect of insulin-like growth factor 1 (IGF-1) on acute lung injury in septic mice and its underlying molecular mechanism.Methods:Twenty SPF male C57BL/6J mice aged 6-8 weeks were randomly (random number) divided into the sham-operated group, sham-operated + IGF-1 group, sepsis group and sepsis + IGF-1 group, with 5 mice in each group. IGF-1 [60 μg/(kg·d)] was injected via the tail vein for 3 consecutive days in the sham-operated + IGF-1 group and sepsis + IGF-1 group, and mice in the sham-operated group and sepsis group were injected with an equal volume of saline. The tissue of the upper lobe of the right lung was taken to calculate the wet-to-dry ratio, and the upper lobe of the left lung was subjected to HE staining to analyze pathological changes and evaluate lung injury. The levels of interleukin (IL)-6 and IL-1β in the bronchoalveolar lavage fluid (BALF) and serum of mice were detected by ELISA. The expression of p-PI3K, PI3K, p-AKT and AKT in lung tissues was determined via Western blotting. The quantitative data with a normal distribution and homogeneity of variance were compared between the two groups by two independent sample t test. Results:Lung volume was reduced in the sepsis group than in the sham-operated group, obvious surface congestion, dark red color, large bruises and hemorrhagic foci were observed under the pericardium, and the wet-to-dry ratio was significantly elevated ( P<0.05). Compared with the sepsis group, the sepsis + IGF-1 group had slightly increased lung volume, less congestion, darker red color, fewer bruises and hemorrhagic foci, and a lower wet-to-dry ratio ( P<0.05). There was no significant change in lung tissue morphology in the sham-operated + IGF-1 group compared with the sham-operated group. HE staining and lung histopathological scores showed that lung tissue was significantly damaged in the sepsis group than the sham-operated group ( P<0.001), and the pathological score of lung tissue was less damaged in the sepsis + IGF-1 group compared with the sepsis group ( P<0.01). The ELISA results demonstrated that the serum levels of IL-6 and IL-1β were markedly decreased in the sepsis + IGF-1 group than in the sepsis group [(26.22±1.60) pg/mL vs. (45.61±7.85) pg/mL, P<0.05; (87.99±11.80) pg/mL vs. (181.26±10.11) pg/mL, P<0.001]. Moreover, the IL-6 and IL-1β contents in the BALF of the sepsis + IGF-1 group were notably lower than those in the BALF of the sepsis group [(7.67±0.42) pg/mL vs. (20.25±0.43) pg/mL, P<0.001; (17.00±6.08) pg/mL vs. (108.61±5.18), pg/mL P <0.001]. Western blot analysis revealed that the expression of p-PI3K, PI3K, p-AKT and AKT in the lung tissues of mice in the sepsis+IGF-1 group were markedly lower than that in the sepsis group [(0.71±0.05) vs. (1.21±0.09), P<0.05; (0.57±0.08) vs. (1.24±0.22), P<0.01; (0.29±0.07) vs. (1.10±0.04), P<0.001; (0.65±0.17) vs. (1.19±0.07), P<0.01]. Conclusion:IGF-1 ameliorates sepsis-induced acute lung injury in mice, and its protective effect may be achieved by inhibiting the PI3K/AKT pathway.