OBJECTIVE: To study effective methods for reducing lung V₅, V₁₀, and mean lung dose (MLD) in the design of volumetric modulated arc therapy for central lung cancer by using different arc configurations and dose-limiting blocks designs. METHODS: Five groups of plans were designed for the enrolled patients. Group A used a full-arc field. Group B used a partial-arc field. Groups C, D, and E used full-arc fields with vertical-length, semi-ring, and triangular dose-limiting blocks added respectively. The dosimetric similarities of target areas and the dosimetric differences in lung V₅, V₁₀, V₂₀, and MLD among the groups were compared. RESULTS: Compared with group A, groups B, C, D, and E had decreased homogeneity and conformity of the target area, but significantly lower V₅ and V₁₀ of the whole lung. The MLD of groups C, D, and E was lower than that of group A. CONCLUSION Using a full-arc field combined with dose-limiting blocks can effectively reduce lung V₅, V₁₀, MLD, and monitor units (MU).
Lung Neoplasms/radiotherapy* ; Humans ; Radiotherapy, Intensity-Modulated/methods* ; Radiotherapy Planning, Computer-Assisted/methods* ; Radiotherapy Dosage ; Lung/radiation effects*

Objective:To summarize the best available evidence for donor and recipient site flap management in head and neck cancer patients undergoing free flap reconstruction.Method:Following the 6S evidence hierarchy model, a comprehensive search was conducted in databases and websites including UpToDate, BMJ Best Practice, Guidelines International Network, National Institute for Health and Care Excellence, National Comprehensive Cancer Network, Joanna Briggs Institute Evidence-Based Healthcare Database, Cochrane Library, PubMed, Embase, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Data. The search period covered all publications up to May 1, 2024.Results:A total of 14 articles were included, comprising two clinical decisions, two guidelines, two systematic reviews, five expert consensuses, two randomized controlled trials, and one prospective cohort study.A total of 28 pieces of evidence were summarized from six aspects: establishing multidisciplinary collaboration, standardized assessment, prehabilitation training, donor site management strategies, recipient site management strategies, and risk identification and management.Conclusions:This study provides a comprehensive summary of evidence regarding donor and recipient site flap management in patients with head and neck cancer undergoing free flap reconstruction, offering an evidence-based foundation for guiding clinical nursing practice.

Objective This study investigated feasible cases and their significance in promoting the"generalized"development of inspection through digital-intelligent equipment.Methods A qualitative research approach was used,involving interviews conducted between February 2025 and March 2025 with experts in traditional Chinese medicine diagnostics,clinical research methodology,medical engineering integration,and related disciplines,using both online and offline methods.In accordance with the Consolidated Criteria for Reporting Qualitative Research,feasible cases involving the specific application of digital equipment in various parts of observation were collected through item enrichment.The significance of extending observation capabilities via these cases was analyzed,along with the overall implications of integrating digital technologies with traditional inspection method.Results Interviews were completed with 11 experts from domestic universities and research institutes in the fields of traditional Chinese medicine diagnosis,medical engineering integration,and related disciplines.A total of 78 feasible cases of digital-intelligent inspection were identified,along with 69 insights regarding the significance of enhancing the inspection capabilities.These insights were synthesized into two dimensions and 23 holistic meanings.The first dimension is to expand the scope of inspection,including obtaining internal environmental characteristics,observing external environmental characteristics,expanding thermodynamic characteristic data,and crossing time and space.The second dimension is to improve the quality of observation and diagnosis information collection and analysis,including 19 specific meanings,such as standardized collection environment,objective quantification,and refined observation.Conclusion Digital-intelligent equipment plays a significant role in expanding the scope of inspection content and achieving high-quality acquisition and analysis of extensive inspection information.These advancements extend and enrich the capabilities of traditional inspection method in traditional Chinese medicine.

Objective:To summarize the best available evidence for donor and recipient site flap management in head and neck cancer patients undergoing free flap reconstruction.Method:Following the 6S evidence hierarchy model, a comprehensive search was conducted in databases and websites including UpToDate, BMJ Best Practice, Guidelines International Network, National Institute for Health and Care Excellence, National Comprehensive Cancer Network, Joanna Briggs Institute Evidence-Based Healthcare Database, Cochrane Library, PubMed, Embase, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Data. The search period covered all publications up to May 1, 2024.Results:A total of 14 articles were included, comprising two clinical decisions, two guidelines, two systematic reviews, five expert consensuses, two randomized controlled trials, and one prospective cohort study.A total of 28 pieces of evidence were summarized from six aspects: establishing multidisciplinary collaboration, standardized assessment, prehabilitation training, donor site management strategies, recipient site management strategies, and risk identification and management.Conclusions:This study provides a comprehensive summary of evidence regarding donor and recipient site flap management in patients with head and neck cancer undergoing free flap reconstruction, offering an evidence-based foundation for guiding clinical nursing practice.

Objective:To observe the characteristics of gastrointestinal tract symptoms in patients with Parkinson′s disease (PD) and analyze the characteristics of these symptoms in patients with different PD subtypes.Methods:A total of 297 PD patients who were admitted to the Neurology Department of the Second Affiliated Hospital of Soochow University from November 2022 to March 2024 were enrolled. The gastrointestinal symptoms of PD patients were evaluated using Drooling Severity and Frequency Scale (DSFS), Sialorrhea Clinical Scale for Parkinson′s disease (SCS-PD), Drooling Rating Scale (DRS), Eating Assessment Tool 10 (EAT-10), Gastroparesis Cardinal Symptom Index (GCSI), and Rome Ⅳ diagnostic criteria. The patients were grouped based on the presence or absence of gastrointestinal symptoms. Additionally, they were stratified according to disease duration (≤2 years, 2-5 years, 5-10 years, and>10 years) and motor symptom subtype [tremor-dominant (TD) vs. postural instability and gait difficulty (PIGD)]. One-way ANOVA and logistic regression analysis were applied to examine between-group differences while Spearman correlation analysis was employed to assess correlations between clinical symptoms.Results:The average age of the patients with PD was 67.0 (60.0, 72.0) years, and 161 (54.2%) were male. The incidence of PD combined with gastrointestinal symptoms was, in descending order: constipation (191, 64.3%), salivation (155, 52.2%), gastroparesis (93, 31.3%), and dysphagia (68, 22.9%). Compared with PD patients without gastrointestinal symptoms, those with symptoms had higher scores in the RBD-HK [12.0 (5.0, 21.5) vs. 5.0 (0.0, 9.0), Z=-3.74, P=0.017], ESS [6.0 (2.0, 12.0) vs. 3.0 (0.0, 6.0), Z=-3.20, P=0.023], and MDS-UPDRS Part Ⅰ [9.0 (5.0, 14.0) vs. 5.0 (2.3, 9.0), Z=-3.61, P=0.014]. The severity of sialorrhea and deglutition disorders, along with the incidence of constipation, all increased with longer disease duration. Patients with the PIGD subtype had higher GCSI scores than those with the TD subtype [0.0 (0.0, 1.9) vs. 0.0 (0.0, 0.0), Z=-3.57, P=0.007]. Across the cohort, sialorrhea, deglutition disorders, gastroparesis, and constipation were positively associated with the H-Y stage, MDS-UPDRS Ⅰ, HAMD, NMSQ, and SCOPA-AUT; EAT-10 scores were negatively correlated with MoCA ( r=-0.171, P<0.05); and GCSI scores were negatively correlated with MMSE and MoCA ( r=-0.154, r=-0.169, both P<0.05). Conclusions:Overall, 84.5% of the patients with PD had one or more gastrointestinal symptoms, and the incidence and severity of gastrointestinal symptoms increased with disease duration. The severity of gastroparesis was higher in the PIGD group than in the TD group. The scores of all gastrointestinal symptoms were positively correlated with the H-Y stage and MDS-UPDRS Ⅰ, while the GCSI scores were negatively correlated with the cognitive scores.

Objective:To characterize the epidemiology of respiratory syndrome across healthcare facilities of different types and tiers in Beijing City, to compare pathogen-testing modalities and their associations with adverse outcomes, and to identify key factors associated with progression to severe illness, thereby informing regional prevention, control, and clinical optimization.Methods:The multicenter observational cohort study was performed using outpatient and emergency department data from five sentinel hospitals in Beijing (Beijing Xiaotangshan Hospital, Beijing Chaoyang District Shuangqiao Hospital, Beijing Haidian Hospital, Beijing You′an Hospital, Capital Medical University (Beijing You′an Hospital), and Beijing Ditan Hospital, Capital Medical University (Beijing Ditan Hospital)) from October 1st, 2023 to April 9th, 2025. Dual-target (two-plex) and triple-target (three-plex) respiratory specimens were collected. Demographic characteristics, visit information, pathogen-testing modalities and results were collected, and the epidemiologic features of patients who progressed to severe illness between the influenza high-incidence season (December to May) and the non-influenza season (June to November) were compared. Categorical variables were analyzed using the chi-square test. Multivariable logistic regression was used to estimate associations between covariates and risk of progression to severe illness.Results:Among the 192 131 cases, patients visited at Beijing You′an Hospital were concentrated in the 16 to 44 year age group, accounting for 66.79%(32 532/48 708). Beijing Xiaotangshan Hospital had a broad age distribution, with older adults comprising up to 22.35% (885/3 960). Of the 47 349 respiratory specimens across the five hospitals, Beijing You′an Hospital had the highest positivity rate for dual-target testing (46.76%(1 585/3 390)), while Beijing Haidian Hospital conducted the largest number of this tests ( n=12 514). For triple-target testing, Beijing You′an Hospital again had the highest positivity rate (45.03%(2 835/6 296)), whereas Beijing Ditan Hospital tested the most specimens ( n=12 011; positivity rate was 29.73%(3 571/12 011)). The influenza season within the same period (November 2023 to January 2024) exhibited a bimodal pattern, with alternating circulation of influenza viruses and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Among 32 744 outpatients/emergency patients who progressed to severe illness, significant seasonal differences were observed by sex, age, comorbidity status, and infection type ( χ2=6.60, 189.24, 32.71 and 189.99, respectively; all P<0.05). After adjustment for sex, age group, comorbidities, and infection type, testing modality remained significantly associated with risk of progression (dual-target testing, odds ratio ( OR)=0.116, 95% confidence interval ( CI) 0.111 to 0.122, P<0.001); no testing, OR=0.063, 95% CI 0.060 to 0.065, P<0.001). Conclusions:The epidemiological pattern of respiratory pathogens undergo significant changes after October 2023, which is characterized by alternating waves of influenza viruses and SARS-CoV-2 with pronounced seasonality and diversity. Substantial inter-hospital differences are observed in testing modalities and positivity rates. Risk of progression to severe illness varies significantly by sex, age, comorbidity burden, and infection type, and is closely associated with the testing modality. These findings support strengthening multiplex pathogen testing and targeted surveillance of high-risk groups to improve early identification and precise control of febrile-respiratory syndromes.

Objective:To observe the characteristics of gastrointestinal tract symptoms in patients with Parkinson′s disease (PD) and analyze the characteristics of these symptoms in patients with different PD subtypes.Methods:A total of 297 PD patients who were admitted to the Neurology Department of the Second Affiliated Hospital of Soochow University from November 2022 to March 2024 were enrolled. The gastrointestinal symptoms of PD patients were evaluated using Drooling Severity and Frequency Scale (DSFS), Sialorrhea Clinical Scale for Parkinson′s disease (SCS-PD), Drooling Rating Scale (DRS), Eating Assessment Tool 10 (EAT-10), Gastroparesis Cardinal Symptom Index (GCSI), and Rome Ⅳ diagnostic criteria. The patients were grouped based on the presence or absence of gastrointestinal symptoms. Additionally, they were stratified according to disease duration (≤2 years, 2-5 years, 5-10 years, and>10 years) and motor symptom subtype [tremor-dominant (TD) vs. postural instability and gait difficulty (PIGD)]. One-way ANOVA and logistic regression analysis were applied to examine between-group differences while Spearman correlation analysis was employed to assess correlations between clinical symptoms.Results:The average age of the patients with PD was 67.0 (60.0, 72.0) years, and 161 (54.2%) were male. The incidence of PD combined with gastrointestinal symptoms was, in descending order: constipation (191, 64.3%), salivation (155, 52.2%), gastroparesis (93, 31.3%), and dysphagia (68, 22.9%). Compared with PD patients without gastrointestinal symptoms, those with symptoms had higher scores in the RBD-HK [12.0 (5.0, 21.5) vs. 5.0 (0.0, 9.0), Z=-3.74, P=0.017], ESS [6.0 (2.0, 12.0) vs. 3.0 (0.0, 6.0), Z=-3.20, P=0.023], and MDS-UPDRS Part Ⅰ [9.0 (5.0, 14.0) vs. 5.0 (2.3, 9.0), Z=-3.61, P=0.014]. The severity of sialorrhea and deglutition disorders, along with the incidence of constipation, all increased with longer disease duration. Patients with the PIGD subtype had higher GCSI scores than those with the TD subtype [0.0 (0.0, 1.9) vs. 0.0 (0.0, 0.0), Z=-3.57, P=0.007]. Across the cohort, sialorrhea, deglutition disorders, gastroparesis, and constipation were positively associated with the H-Y stage, MDS-UPDRS Ⅰ, HAMD, NMSQ, and SCOPA-AUT; EAT-10 scores were negatively correlated with MoCA ( r=-0.171, P<0.05); and GCSI scores were negatively correlated with MMSE and MoCA ( r=-0.154, r=-0.169, both P<0.05). Conclusions:Overall, 84.5% of the patients with PD had one or more gastrointestinal symptoms, and the incidence and severity of gastrointestinal symptoms increased with disease duration. The severity of gastroparesis was higher in the PIGD group than in the TD group. The scores of all gastrointestinal symptoms were positively correlated with the H-Y stage and MDS-UPDRS Ⅰ, while the GCSI scores were negatively correlated with the cognitive scores.

Objective:To characterize the epidemiology of respiratory syndrome across healthcare facilities of different types and tiers in Beijing City, to compare pathogen-testing modalities and their associations with adverse outcomes, and to identify key factors associated with progression to severe illness, thereby informing regional prevention, control, and clinical optimization.Methods:The multicenter observational cohort study was performed using outpatient and emergency department data from five sentinel hospitals in Beijing (Beijing Xiaotangshan Hospital, Beijing Chaoyang District Shuangqiao Hospital, Beijing Haidian Hospital, Beijing You′an Hospital, Capital Medical University (Beijing You′an Hospital), and Beijing Ditan Hospital, Capital Medical University (Beijing Ditan Hospital)) from October 1st, 2023 to April 9th, 2025. Dual-target (two-plex) and triple-target (three-plex) respiratory specimens were collected. Demographic characteristics, visit information, pathogen-testing modalities and results were collected, and the epidemiologic features of patients who progressed to severe illness between the influenza high-incidence season (December to May) and the non-influenza season (June to November) were compared. Categorical variables were analyzed using the chi-square test. Multivariable logistic regression was used to estimate associations between covariates and risk of progression to severe illness.Results:Among the 192 131 cases, patients visited at Beijing You′an Hospital were concentrated in the 16 to 44 year age group, accounting for 66.79%(32 532/48 708). Beijing Xiaotangshan Hospital had a broad age distribution, with older adults comprising up to 22.35% (885/3 960). Of the 47 349 respiratory specimens across the five hospitals, Beijing You′an Hospital had the highest positivity rate for dual-target testing (46.76%(1 585/3 390)), while Beijing Haidian Hospital conducted the largest number of this tests ( n=12 514). For triple-target testing, Beijing You′an Hospital again had the highest positivity rate (45.03%(2 835/6 296)), whereas Beijing Ditan Hospital tested the most specimens ( n=12 011; positivity rate was 29.73%(3 571/12 011)). The influenza season within the same period (November 2023 to January 2024) exhibited a bimodal pattern, with alternating circulation of influenza viruses and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Among 32 744 outpatients/emergency patients who progressed to severe illness, significant seasonal differences were observed by sex, age, comorbidity status, and infection type ( χ2=6.60, 189.24, 32.71 and 189.99, respectively; all P<0.05). After adjustment for sex, age group, comorbidities, and infection type, testing modality remained significantly associated with risk of progression (dual-target testing, odds ratio ( OR)=0.116, 95% confidence interval ( CI) 0.111 to 0.122, P<0.001); no testing, OR=0.063, 95% CI 0.060 to 0.065, P<0.001). Conclusions:The epidemiological pattern of respiratory pathogens undergo significant changes after October 2023, which is characterized by alternating waves of influenza viruses and SARS-CoV-2 with pronounced seasonality and diversity. Substantial inter-hospital differences are observed in testing modalities and positivity rates. Risk of progression to severe illness varies significantly by sex, age, comorbidity burden, and infection type, and is closely associated with the testing modality. These findings support strengthening multiplex pathogen testing and targeted surveillance of high-risk groups to improve early identification and precise control of febrile-respiratory syndromes.

Objective Establish a relationship model between the outcome of inpatient rehabilitation treatment and the influencing factors of rehabilitation effect,explore the evaluation method of inpatient rehabilitation service effect.Methods Using a neural network model to construct a functional relationship model between the outcomes of inpatient rehabilitation treatment and the factors affecting rehabilitation effectiveness,in order to predict the expected rehabilitation outcomes of patients receiving inpatient treatment.Compare the distribution of the difference between the actual discharge ICF total score and the predicted ICF total score to determine the effectiveness of rehabilitation treatment.Results As a result,a total of 1 334 hospitalized rehabilitation cases of brain injury patients were included in this study for analysis.Based on the evaluation indicators and standards of prediction accuracy,the optimal model was selected and the rehabilitation effect was evaluated.Conclusion Based on the ICF-RS-17 measurement of patient entry and exit function scores,the functional status of hospitalized rehabilitation patients themselves,and related possible influencing factors,a relationship model between inpatient rehabilitation treatment outcomes and influencing factors is constructed.It provides a certain scientific basis for establishing an effective evaluation method for the actual clinical rehabilitation effect,and also provides reference suggestions for the realization of value-based payment of rehabilitation medical insurance.

Objective Establish a relationship model between the outcome of inpatient rehabilitation treatment and the influencing factors of rehabilitation effect,explore the evaluation method of inpatient rehabilitation service effect.Methods Using a neural network model to construct a functional relationship model between the outcomes of inpatient rehabilitation treatment and the factors affecting rehabilitation effectiveness,in order to predict the expected rehabilitation outcomes of patients receiving inpatient treatment.Compare the distribution of the difference between the actual discharge ICF total score and the predicted ICF total score to determine the effectiveness of rehabilitation treatment.Results As a result,a total of 1 334 hospitalized rehabilitation cases of brain injury patients were included in this study for analysis.Based on the evaluation indicators and standards of prediction accuracy,the optimal model was selected and the rehabilitation effect was evaluated.Conclusion Based on the ICF-RS-17 measurement of patient entry and exit function scores,the functional status of hospitalized rehabilitation patients themselves,and related possible influencing factors,a relationship model between inpatient rehabilitation treatment outcomes and influencing factors is constructed.It provides a certain scientific basis for establishing an effective evaluation method for the actual clinical rehabilitation effect,and also provides reference suggestions for the realization of value-based payment of rehabilitation medical insurance.