Objective:To compare the dosimetric parameters under different incremental modes between intensity-modulated radiation therapy(IMRT)and volume rotation intensity-modulated therapy(VMAT)for the target area of large volume brain metastases(BMs),and to explore the better way of treating BMs based on hypofractionated stereotactic radiotherapy(HSRT)of linear accelerator.Methods:A total of 30 BMs patients who underwent IMRT at The 971th Hospital of Navy of the CPLA from 2020 to 2023 were selected.In the treatment planning system(TPS),three types of IMRT plans and VMAT plans were designed,which included uniformity plan(Planuniformity)of target area dose,uniform increased plan(Planuniform increased-dose)and incremental plan(Planincremental)within target area.In the inside of the target area,the target area of high dose(GTVh)was set,and Planuniform increased-dose and Planincremental were designed to aim at GTVh.The differences of the doses of three types of treatment plans included Planuniformity,Planuniform increased-dose and Planincremental,which were respectively designed by using IMRT and VMAT,were analyzed.The mean dose(Dmean)of the target area,the 50%and 2%exposed doses(D50%and D2%)of the target area were observed and compared.The conformity index(CI),homogeneity index(HI),gradient index(GI),and the volume percentage(V10 Gy-V40 Gy)that normal brain tissue received 10 Gy-40 Gy also were observed and compared.Results:Compared with Planuniformity of IMRT,the Dmean of GTV of Planuniform increased-dose and Planincremental of IMRT increased by 10.13%and 17.9%,with statistically significant differences(t=13.680,12.771,P＜0.05).D50%increased by 8.9%and 10.8%,with statistically significant differences(t=15.190,9.929,P＜0.05).D2%increased by 15.2%and 46.4%,with statistically significant differences(t=52.320,8.746,P＜0.05).There were no statistically significant differences in normal brain tissue V10 Gy-V40 Gy among Planuniformity,Planuniform increased-dose and Planincremental of IMRT(P＞0.05).Compared with Planuniformity of VMAT,the Dmean of GTV of Planuniform increased-dose and Planincremental of VMAT increased by 10.53%and 21.23%,with statistically significant differences(t=18.641,15.461,P＜0.05),and D50%increased by 9.1%and 13.4%,with statistically significant differences(t=11.382,10.952,P＜0.05),and D2%increased by 16.4%and 48.8%,with statistically significant differences(t=56.471,8.685,P＜0.05),respectively.There were no statistically significant differences in normal brain tissue V10 Gy-V40 Gy among Planuniformity,Planuniform increased-dose and Planincremental of VMAT(P＞0.05).The normal brain tissue V20 Gy,V30 Gy and V40 Gy of Planuniform increased-dose and Planincremental of IMRT were respectively less than those of VMAT,and the differences of them between IMRT and VMAT were significant(tPlan uniform increased-dose=2.112,2.215,2.444,tPlan incremental=2.323,2.939,3.145,P＜0.05).There were no statistically significant difference in D2%,Dmean,and D50%between IMRT and VMAT(P＞0.05).Conclusion:On the premise of ensuring the safety of normal brain tissue at the edge of the target area,the synchronously increasing of the central dose of the target area will not significantly increase the dose for normal brain tissue.Both IMRT and VMAT can meet the requirements of increment in the inside of the target area,and VMAT has slightly better increment and higher efficiency within target area.The incremental of VMAT target area is slightly better,which also has better efficiency,while the enhancement effect of the dose of target area of Planincremental is better than that of the Planuniform increased-dose.The Plan incremental of VMAT is more suitable for HSRT treatment for BMs.

Radiation-induced lung injury is a prevalent side effect of radiotherapy for chest cancer. The "three phases and three methods "is an innovative theory based on the evolution of the core pathogenesis of radiation-induced lung injury. Its formation also considers the understanding of radiation-induced lung injury by ancient and modern medical practitioners, pathological characteristics, clinical manifestations, and the development patterns of radiation-induced lung injury. The "three phases and three methods" refers to the three phases of the course and the three treatment methods. The core pathogenesis of radiation-induced lung injury from the beginning, middle and late stages is heat toxicity, yin deficiency, and blood stasis. Therefore, the course of radiation-induced lung injury is divided into three phases: blazing heat toxin, yin deficiency and heat accumulation, and static blood obstruction. The method of clearing the lung and resolving toxins, enriching yin and venting heat, invigorating blood and dissolving stasis are used respectively. Traditional Chinese medicines commonly used in each phase include Flos Lonicerae, Atrina Glass, heartleaf houttuynia herb, Radix Ophiopogonis, American Ginseng, Forsythiae Fructus, Radix Salviae Miltiorrhizae, Rhizoma Ligustici chuanxiong, Scorpio, etc. This article presents the theoretical origins of the "three phases and three methods" concept by reviewing of ancient literature, inheriting experience, and summarizing disease pathogenesis, as well as elaborating on the academic connotations of the "three phases and three methods". The scientific validity of the "three phases and three methods" is verified by literature, clinical, and basic research. The "three phases and three methods" interprets the core characteristics of each stage of radiation-induced lung injury, improves the traditional Chinese medicine prevention and treatment system for radiation-induced lung injury, and provides theoretical basis for achieving complete process management.

Objective To investigate the current status of adherence to home ultrafiltration volume measurement in peri-toneal dialysis(PD)patients and explore its influencing factors,providing a basis for optimizing volume management strategies.Methods A cross-sectional study design was adopted.In March 2024,a questionnaire survey was conducted among 324 regular-ly followed-up patients at the Peritoneal Dialysis Center of the First Affiliated Hospital of Xi'an Jiaotong University.The question-naire covered demographic characteristics,ultrafiltration volume recording behaviors,measurement method awareness,and instru-ment preferences.Possible factors influencing adherence to ultrafiltration volume measurement were analyzed.Results The o-verall compliance rate for recording patients' ultrafiltration volume was 56.2％(182/324)％.The completion rate of measure-ment was better in the measuring cup group compared to the weighing method(57.3％vs 47.4％,P=0.034).However,Meas-urement compliance decreased with prolonged dialysis duration(P=0.021).78.39％of patients could identify emergency situa-tions of volume expansion(e.g.,sudden decrease in ultrafiltration volume accompanied by elevated blood pressure).However,patients with lower education levels(below high school)had poorer awareness of volume changes compared to those with higher education(81.4％vs 18.5％,x2=9.946,P=0.041).The recognition rate for volume depletion was significantly lower than that for volume expansion(x2=7.163,P=0.008).Multivariate logistic regression analysis showed that higher education level(OR=0.404,95％CI 0.228-0.717,P=0.002),family assistance in measurement(OR=0.361,95％CI 0.183-0.713,P=0.003),and strong belief that measurement helps doctors adjust prescriptions(OR=0.371,95％CI 0.187-0.736,P=0.005)were protective factors for compliance with ultrafiltration volume measurement in peritoneal dialysis patients.Longer dialysis dura-tion(OR=4.732,95％CI 2.315-9.674,P＜0.001)and perception of measurement as troublesome(OR=4.802,95％CI 2.787-8.272,P＜0.001)were independent risk factors for poor compliance with ultrafiltration measurement.Compared with pa-tients with low educational level,patients with high educational level had higher requirements for the ease of operation(38.6％vs 61.4％,x2=15.033,P＜0.001),cost performance(41.1％vs 58.9％,x2=13.335,P＜0.001),and durability(38.2％vs 61.8％,x2=4.558,P=0.033)of the new ultrafiltration measurement equipment.Conclusion ① Long dialysis duration,per-ceived measurement inconvenience,low education level,self-measurement,and insufficient trust in physicians are independent risk factors for poor adherence to home ultrafiltration volume measurement among PD patients.②The vast majority of patients can recognize emergency situations involving sudden volume overload,but their awareness and recognition of volume depletion require further improvement.③New measuring instruments,such as intelligent measuring cups,with easy-to-use operations can be pro-moted.When combined with remote monitoring technology,they help patients identify capacity insufficiency promptly and im-prove the rate of early intervention.

Objective Network pharmacology and molecular docking techniques were used to predict the potential mechanisms by which the active components of Piper nigrum(PN)regulate depressive-like behaviors in chronic restraint stress(CRS)mice.Methods The major chemical components and targets of PN were screened using the Traditional Chinese Medicine Systems Pharmacology database.Targets related to ferroptosis and depression were obtained from the Online Mendelian Inheritance in Man,GeneCards,and FerrDB databases.The intersecting targets were then subjected to Gene Ontology and Kyoto Encyclopedia of Genes and Gnomes(KEGG)pathway enrichment analyses,and molecular docking was performed to validate the binding capacities between the core targets and their corresponding active components.Finally,we established a CRS mouse model.Mice were treated with PN 75,150,and 300 mg/kg for 4 weeks,followed by behavioral assessments and reverse transcription-quantitative polymerase chain reaction(RT-qPCR)to verify the expression of core genes.Results Nine active components were screened from PN,corresponding to 27 targets,and 8377 targets related to depression and 547 targets associated with ferroptosis were screened from the databases.The intersection of these three sets resulted in 25 target genes.KEGG enrichment analysis revealed that these core targets were predominantly enriched in signaling pathways,including cholinergic synapses,serotonergic synapses,and neuroactive ligand-receptor interactions.Molecular docking result showed that the main active components of PN had strong binding affinities for the targets CHRM2,SLC6A4,PTGS2,and SLC6A2.Behavioral assessments demonstrated that PN significantly increased the sucrose preference index(P＜0.01,P＜0.001),reduced immobility time in the tail suspension and forced swimming tests(P＜0.01,P＜0.001),and enhanced exploratory behavior in the open field test(P＜0.05.P＜0.01,P＜0.001).PN significantly reduced the serum levels of inflammation markers(P＜0.05.P＜0.01,P＜0.001),as shown by enzyme-linked immunosorbent assay,and neurotransmitter analysis revealed that PN significantly increased the levels of serotonin and acetylcholine in the mouse hippocampus(P＜0.05).RT-qPCR showed that PN demonstrated the mRNA expression of SLC6A4(P＜0.05.P＜0.01,P＜0.001).Conclusions PN may improve depressive-like behavior in mice by modulating serotonin and acetylcholine levels,inhibiting inflammatory responses,participating in immune regulation,and exerting neuroprotective effects.

Objective To investigate the current status of adherence to home ultrafiltration volume measurement in peri-toneal dialysis(PD)patients and explore its influencing factors,providing a basis for optimizing volume management strategies.Methods A cross-sectional study design was adopted.In March 2024,a questionnaire survey was conducted among 324 regular-ly followed-up patients at the Peritoneal Dialysis Center of the First Affiliated Hospital of Xi'an Jiaotong University.The question-naire covered demographic characteristics,ultrafiltration volume recording behaviors,measurement method awareness,and instru-ment preferences.Possible factors influencing adherence to ultrafiltration volume measurement were analyzed.Results The o-verall compliance rate for recording patients' ultrafiltration volume was 56.2％(182/324)％.The completion rate of measure-ment was better in the measuring cup group compared to the weighing method(57.3％vs 47.4％,P=0.034).However,Meas-urement compliance decreased with prolonged dialysis duration(P=0.021).78.39％of patients could identify emergency situa-tions of volume expansion(e.g.,sudden decrease in ultrafiltration volume accompanied by elevated blood pressure).However,patients with lower education levels(below high school)had poorer awareness of volume changes compared to those with higher education(81.4％vs 18.5％,x2=9.946,P=0.041).The recognition rate for volume depletion was significantly lower than that for volume expansion(x2=7.163,P=0.008).Multivariate logistic regression analysis showed that higher education level(OR=0.404,95％CI 0.228-0.717,P=0.002),family assistance in measurement(OR=0.361,95％CI 0.183-0.713,P=0.003),and strong belief that measurement helps doctors adjust prescriptions(OR=0.371,95％CI 0.187-0.736,P=0.005)were protective factors for compliance with ultrafiltration volume measurement in peritoneal dialysis patients.Longer dialysis dura-tion(OR=4.732,95％CI 2.315-9.674,P＜0.001)and perception of measurement as troublesome(OR=4.802,95％CI 2.787-8.272,P＜0.001)were independent risk factors for poor compliance with ultrafiltration measurement.Compared with pa-tients with low educational level,patients with high educational level had higher requirements for the ease of operation(38.6％vs 61.4％,x2=15.033,P＜0.001),cost performance(41.1％vs 58.9％,x2=13.335,P＜0.001),and durability(38.2％vs 61.8％,x2=4.558,P=0.033)of the new ultrafiltration measurement equipment.Conclusion ① Long dialysis duration,per-ceived measurement inconvenience,low education level,self-measurement,and insufficient trust in physicians are independent risk factors for poor adherence to home ultrafiltration volume measurement among PD patients.②The vast majority of patients can recognize emergency situations involving sudden volume overload,but their awareness and recognition of volume depletion require further improvement.③New measuring instruments,such as intelligent measuring cups,with easy-to-use operations can be pro-moted.When combined with remote monitoring technology,they help patients identify capacity insufficiency promptly and im-prove the rate of early intervention.

BACKGROUND: Metabolic-associated fatty liver disease (MAFLD) is the predominant form of chronic liver disease worldwide. This study was designed to investigate the proportion and characteristics of MAFLD within the general Chinese population and to identify the contributory risk factors for liver fibrosis among MAFLD individuals. METHODS: The participants were recruited from a cohort undergoing routine health evaluations at the Third Hospital of Hebei Medical University between May 2019 and March 2023. The diagnosis of MAFLD was based on the established clinical practice guidelines. The fibrosis-4 index score (FIB-4) was employed to evaluate hepatic fibrosis, with a FIB-4 score of ≥1.3 indicating significant fibrosis. Binary logistic regression analyses were used to determine risk factors associated with significant hepatic fibrosis in MAFLD. RESULTS: A total of 22,970 participants who underwent comprehensive medical examinations were included in the analysis. The overall proportion of MAFLD was 28.77% (6608/22,970), with 16.87% (1115/6608) of these patients showing significant fibrosis as assessed using FIB-4. Independent risk factors for significant liver fibrosis in MAFLD patients were male (odds ratio [OR] = 0.676, 95% confidence interval [CI]: 0.558-0.821), hepatitis B surface antigen (HBsAg) positivity (OR = 2.611, 95% CI: 1.557-4.379), body mass index ≥23.00 kg/m 2 (OR = 0.632, 95% CI: 0.470-0.851), blood pressure ≥130/85 mmHg (OR = 1.885, 95% CI: 1.564-2.272), and plasma glucose ≥5.6 mmol/L (OR = 1.815, 95% CI: 1.507-2.186) (all P <0.001). CONCLUSIONS The proportion of MAFLD in an urban Chinese population is 28.77%. About 16.87% of MAFLD patients presented with significant liver fibrosis. Independent risk factors for significant liver fibrosis in MAFLD patients should be noticed.
Humans ; Male ; Female ; Liver Cirrhosis/pathology* ; Middle Aged ; Risk Factors ; Adult ; Fatty Liver/pathology* ; Aged ; China/epidemiology* ; Logistic Models ; Urban Population ; East Asian People

Objective:To compare the dosimetric parameters under different incremental modes between intensity-modulated radiation therapy(IMRT)and volume rotation intensity-modulated therapy(VMAT)for the target area of large volume brain metastases(BMs),and to explore the better way of treating BMs based on hypofractionated stereotactic radiotherapy(HSRT)of linear accelerator.Methods:A total of 30 BMs patients who underwent IMRT at The 971th Hospital of Navy of the CPLA from 2020 to 2023 were selected.In the treatment planning system(TPS),three types of IMRT plans and VMAT plans were designed,which included uniformity plan(Planuniformity)of target area dose,uniform increased plan(Planuniform increased-dose)and incremental plan(Planincremental)within target area.In the inside of the target area,the target area of high dose(GTVh)was set,and Planuniform increased-dose and Planincremental were designed to aim at GTVh.The differences of the doses of three types of treatment plans included Planuniformity,Planuniform increased-dose and Planincremental,which were respectively designed by using IMRT and VMAT,were analyzed.The mean dose(Dmean)of the target area,the 50%and 2%exposed doses(D50%and D2%)of the target area were observed and compared.The conformity index(CI),homogeneity index(HI),gradient index(GI),and the volume percentage(V10 Gy-V40 Gy)that normal brain tissue received 10 Gy-40 Gy also were observed and compared.Results:Compared with Planuniformity of IMRT,the Dmean of GTV of Planuniform increased-dose and Planincremental of IMRT increased by 10.13%and 17.9%,with statistically significant differences(t=13.680,12.771,P＜0.05).D50%increased by 8.9%and 10.8%,with statistically significant differences(t=15.190,9.929,P＜0.05).D2%increased by 15.2%and 46.4%,with statistically significant differences(t=52.320,8.746,P＜0.05).There were no statistically significant differences in normal brain tissue V10 Gy-V40 Gy among Planuniformity,Planuniform increased-dose and Planincremental of IMRT(P＞0.05).Compared with Planuniformity of VMAT,the Dmean of GTV of Planuniform increased-dose and Planincremental of VMAT increased by 10.53%and 21.23%,with statistically significant differences(t=18.641,15.461,P＜0.05),and D50%increased by 9.1%and 13.4%,with statistically significant differences(t=11.382,10.952,P＜0.05),and D2%increased by 16.4%and 48.8%,with statistically significant differences(t=56.471,8.685,P＜0.05),respectively.There were no statistically significant differences in normal brain tissue V10 Gy-V40 Gy among Planuniformity,Planuniform increased-dose and Planincremental of VMAT(P＞0.05).The normal brain tissue V20 Gy,V30 Gy and V40 Gy of Planuniform increased-dose and Planincremental of IMRT were respectively less than those of VMAT,and the differences of them between IMRT and VMAT were significant(tPlan uniform increased-dose=2.112,2.215,2.444,tPlan incremental=2.323,2.939,3.145,P＜0.05).There were no statistically significant difference in D2%,Dmean,and D50%between IMRT and VMAT(P＞0.05).Conclusion:On the premise of ensuring the safety of normal brain tissue at the edge of the target area,the synchronously increasing of the central dose of the target area will not significantly increase the dose for normal brain tissue.Both IMRT and VMAT can meet the requirements of increment in the inside of the target area,and VMAT has slightly better increment and higher efficiency within target area.The incremental of VMAT target area is slightly better,which also has better efficiency,while the enhancement effect of the dose of target area of Planincremental is better than that of the Planuniform increased-dose.The Plan incremental of VMAT is more suitable for HSRT treatment for BMs.

Objective Network pharmacology and molecular docking techniques were used to predict the potential mechanisms by which the active components of Piper nigrum(PN)regulate depressive-like behaviors in chronic restraint stress(CRS)mice.Methods The major chemical components and targets of PN were screened using the Traditional Chinese Medicine Systems Pharmacology database.Targets related to ferroptosis and depression were obtained from the Online Mendelian Inheritance in Man,GeneCards,and FerrDB databases.The intersecting targets were then subjected to Gene Ontology and Kyoto Encyclopedia of Genes and Gnomes(KEGG)pathway enrichment analyses,and molecular docking was performed to validate the binding capacities between the core targets and their corresponding active components.Finally,we established a CRS mouse model.Mice were treated with PN 75,150,and 300 mg/kg for 4 weeks,followed by behavioral assessments and reverse transcription-quantitative polymerase chain reaction(RT-qPCR)to verify the expression of core genes.Results Nine active components were screened from PN,corresponding to 27 targets,and 8377 targets related to depression and 547 targets associated with ferroptosis were screened from the databases.The intersection of these three sets resulted in 25 target genes.KEGG enrichment analysis revealed that these core targets were predominantly enriched in signaling pathways,including cholinergic synapses,serotonergic synapses,and neuroactive ligand-receptor interactions.Molecular docking result showed that the main active components of PN had strong binding affinities for the targets CHRM2,SLC6A4,PTGS2,and SLC6A2.Behavioral assessments demonstrated that PN significantly increased the sucrose preference index(P＜0.01,P＜0.001),reduced immobility time in the tail suspension and forced swimming tests(P＜0.01,P＜0.001),and enhanced exploratory behavior in the open field test(P＜0.05.P＜0.01,P＜0.001).PN significantly reduced the serum levels of inflammation markers(P＜0.05.P＜0.01,P＜0.001),as shown by enzyme-linked immunosorbent assay,and neurotransmitter analysis revealed that PN significantly increased the levels of serotonin and acetylcholine in the mouse hippocampus(P＜0.05).RT-qPCR showed that PN demonstrated the mRNA expression of SLC6A4(P＜0.05.P＜0.01,P＜0.001).Conclusions PN may improve depressive-like behavior in mice by modulating serotonin and acetylcholine levels,inhibiting inflammatory responses,participating in immune regulation,and exerting neuroprotective effects.

To address the challenges of complex digital model management and difficulties in model interoperability during the development of sophisticated products,this paper proposes an intelligent cloud architecture-based method for MBSE(model-based systems engineering)model microservice aggregation and adaptive integration.By introducing ontology semantic annotation and hash encoding mechanisms,we achieve unified encapsulation and service-oriented management of heterogeneous modeling tool resources.Combined with model virtual execution modes and dynamic resource orchestration technology,we design a task-oriented of Model-Based Microservice Deployment Framework,significantly improving model service scheduling efficiency and resource utilization.Leveraging a service-cluster-based model aggregation approach,we employ Hamming distance to calculate model capability compatibility,optimizing model discovery and orchestration processes.The prototype implementation and multi-phase experimental validation conducted in a domestic private cloud environment demonstrate that the proposed method effectively supports digital development across the entire lifecycle of aerospace products,enhancing model resource sharing and system integration efficiency.

Objective To investigate whether suffering from atrial fibrillation in different ages of people increasing the onset risk of new-onset acute myocardial infarction(AMI).Methods A prospective cohort study was conducted to select 96 624 Kailuan Group employees undergoing the health examination from June 2006 to October 2007 for including the study.The participants were followed up once a year,and the last fol-low-up date was December 31,2020,with a median follow-up of 14.01 years,and the endpoint event was new-onset AMI.The participants were divided into two age groups according to the age ≥60 years and the age＜60 years old,and divided into the atrial fibrillation group and non-atrial fibrillation group according to whether they had atrial fibrillation.The epidemiological investigation and anthropometric measurements were carried out on the participates.Whether atrial fibrillation was correlated to the onset of new-onset AMI in different age groups conducted the statistical analysis.Results Among the total participants,there were 411 cases in the atrial fibrillation group and 96 213 cases in the non-atrial fibrillation group.Among the participants＜60 years old,there were 121 cases in the atrial fibrillation group and 75 151 cases in the non-atrial fibrillation group.Among the participants ≥60 years old,there were 290 cases in the atrial fibrillation group and 21 062 cases in the non-atrial fibrillation group.In the total participants,the cumulative incidence rate of AMI in the atrial fibrillation group was higher than that in the non-atrial fibrillation group(5.68％vs.1.92％),and the difference was statistically significant(P＜0.05).In the participants＜60 years old,the cumulative incidence rate of AMI in the atrial fibrillation group was higher than that in the non-atrial fibrillation group(7.40％vs.1.43％),and the difference was statistically significant(P＜0.05).In the participants 60 year old,the cu-mulative incidence rate of AMI had no statistical difference between the atrial fibrillation group and non-atrial fibrillation group(4.54％vs.3.87％,P=0.547).In the whole participants,atrial fibrillation was a risk factor for new-onset AMI(HR=1.877,95％CI:1.177-2.991,P=0.008),and there was an interaction between age and atrial fibrillation(P=0.016).In the age stratification analysis,atrial fibrillation was a risk factor for new-onset AMI in＜60-year-old population(HR=3.029,95％CI:1.508-6.082,P=0.002).Conclusion Atrial fibrillation is an independent risk factor for new-onset AMI,especially to young and middle-aged people(＜60 years old).