Using the hybrid type 1 implementation study "The Shared Medical Appointment for diabetes in China: an optimization trial(SMART)" as an example, this study introduces the methods of constructing and validating an outcome indicator set for hybrid type 1 studies.

Aim To elucidate the underlying mecha-nism by which total triterpenoids extracted from Hove-nia dulcis(H-TP)enhance the sensitivity of A549/DDP cells to cisplatin.Methods The ARE-Nrf2 lu-ciferase reporter assay was applied to investigate the impact of H-TP on Nrf2 expression.Western blot was used to detect the protein levels of Keap-1/Nrf2/HO-1,Nrf2-GPX4 signaling pathway,apoptosis-related proteins of Bcl-2 and Bax.Further validation of its effects on Nrf2 was conducted by using Nrf2 activator/inhibitor.Results H-TP could enhance the sensitivi-ty of A549/DDP cells to cisplatin by modulating the expression of apoptosis-related proteins Bax and Bcl-2,inhibiting the Keap-1/Nrf2/HO-1/GPX4 signating pathway in A549/DDP cells,and inducing ferroptosis.Conclusion H-TP enhances the sensitivity of A549/DDP cells to cisplatin by inducing the Nrf2-mediated ferroptosis pathway.

Pancreatic cancer is highly aggressive and often diagnosed at an advanced stage,leaving most patients ineligible for radical resection.This study retrospectively analyzed four patients with locally advanced or advanced pancreatic cancer to evaluate the clinical efficacy and safety of high-intensity focused ultrasound(HIFU)ablation combined with chemotherapy as a neoadjuvant and conversion therapy.All cases were reviewed and individualized treatment plans were formulated through a multidisciplinary team evaluation.All patients received HIFU plus gemcitabine and nab-paclitaxel chemotherapy,with assessments of tumor volume,vascular involvement,surgical conversion,symptom relief,and adverse events.Three patients achieved marked tumor shrinkage and reduction of vascular invasion,enabling successful R0 resection without recurrence during follow-up.The remaining patient achieved disease stability,significant pain relief,and maintained good quality of life under repeated HIFU therapy.All treatments were well tolerated,and no severe adverse reactions occurred.The combination of HIFU and chemotherapy demonstrated synergistic local and systemic effects,effectively achieving tumor downstaging,improving resectability,and alleviating symptoms.As a safe,noninvasive,and repeatable therapeutic approach,this strategy offers a promising option for patients with advanced pancreatic cancer.Further large-scale prospective studies are warranted to validate its long-term efficacy and elucidate underlying mechanisms.

The application of artificial intelligence(AI)technology in healthcare-associated infection prevention and control deepens continuously.It demonstrates a potential for achieving precise prevention and control of infec-tion through data integration,model construction,and dynamic analysis,and provides scientific support for optimi-zation of decision-making in relevant departments.However,the application of related technologies still faces multi-ple challenges,such as data quality,system compatibility,and adaptation to actual scenarios,which limits its com-prehensive promotion in clinical settings.Based on this,this study systematically summarizes the research progress of AI application in infection prediction,diagnosis support,behavior optimization,and resource management in re-cent years,deeply analyzes its key technical advantages and limitations,and proposes improvement strategies for existing problems and future development directions,with a view to providing theoretical support and practical refe-rences for the intelligent transformation of infection prevention and control in hospitals in China.

Aim To elucidate the underlying mecha-nism by which total triterpenoids extracted from Hove-nia dulcis(H-TP)enhance the sensitivity of A549/DDP cells to cisplatin.Methods The ARE-Nrf2 lu-ciferase reporter assay was applied to investigate the impact of H-TP on Nrf2 expression.Western blot was used to detect the protein levels of Keap-1/Nrf2/HO-1,Nrf2-GPX4 signaling pathway,apoptosis-related proteins of Bcl-2 and Bax.Further validation of its effects on Nrf2 was conducted by using Nrf2 activator/inhibitor.Results H-TP could enhance the sensitivi-ty of A549/DDP cells to cisplatin by modulating the expression of apoptosis-related proteins Bax and Bcl-2,inhibiting the Keap-1/Nrf2/HO-1/GPX4 signating pathway in A549/DDP cells,and inducing ferroptosis.Conclusion H-TP enhances the sensitivity of A549/DDP cells to cisplatin by inducing the Nrf2-mediated ferroptosis pathway.

Objective:To investigate the efficacy and safety of oral maintenance therapy with tegafur for residual lesions in patients with locally advanced esophageal squamous cell carcinoma (ESCC) after chemoradiotherapy.Methods:A retrospective cohort study was conducted. A total of 38 patients with locally advanced ESCC who had residual lesions after receiving albumin bound paclitaxel combined with platinum chemoradiotherapy from March 2019 to September 2021 in Jiangsu Province Suqian Hospital were selected. All patients were divided into the maintenance treatment group (20 cases) and the non-maintenance treatment group (18 cases) based on whether they received oral maintenance therapy with tegafur after chemoradiotherapy. The progression-free survival (PFS) of both groups was compared and the adverse reactions of the maintenance treatment group were analyzed.Results:There were no statistically significant differences in baseline data between the 2 groups (both P > 0.05). The 1, 2, 3-year PFS rates for the maintenance treatment group were 95.0%, 78.1%, and 58.3%, respectively, with a median PFS time of 33.65 months (95% CI: 29.04-38.26 months); the 1, 2, 3-year PFS rates in the non-maintenance treatment group were 88.9%, 54.5%, and 12.1%, respectively, with a median PFS time of 25.08 months (95% CI: 20.97-29.18 months); there was a statistically significant difference in PFS between the 2 groups ( χ2 = 5.36, P = 0.021). The common adverse reactions in the maintenance treatment group included hematological adverse reactions, hand foot syndrome, decreased appetite, and fatigue. The more common adverse reactions were neutropenia [85.0% (17/20)] and leukopenia [65.0% (13/20)]; 9 cases experienced grade 3-4 adverse reactions, which were relieved by adjusting the dosage or discontinuing the medication. Conclusions:Oral maintenance therapy with tegafur may improve the survival of ESCC patients with residual lesions after chemoradiotherapy and the adverse reactions are controllable.

Congenital heart disease (CHD) may result from various risk factors including genetic, epigenetic, and environmental elements. The parallel and synchronous development of the placenta and fetal heart establishes a regulatory relationship known as the placenta-heart axis. Placental insufficiency may impact fetal cardiac development, while abnormal cardiac development can conversely disrupt placental structure and function. This review examines the association between placental abnormalities and CHD, providing insights into the etiology and underlying mechanisms of CHD.

Objective:To establish daily quality assurance workflow based on self-developed phantom to ensure MR-linac performance such as beam accuracy, MR image guidance accuracy, and the clinical treatment workflow to enhance the efficiency of daily quality assurance (QA).Methods:The self-developed phantom was made by 3D printer and used in conjunction with Daily QA-MR detector array. After CT-sim scanning, a treatment plan was designed and transmitted to the accelerator, tests were performed such as image guidance accuracy, beam output and beam quality, the differences in daily QA results between the self-developed phantom and standard phantom recommended by the manufacturer were analyzed by using paired t-test. Results:A total of 24 sets results were collected, the image guide accuracy in the X, Y and Z directions between standard and self-made phantom were (0.1±0.4), (-0.14±0.16), (0.07±0.05) mm and (0±0.02), (-0.02±0.02), (0.02±0.01) mm, respectively, and the differences were statistically significant ( P<0.001, =0.001 and <0.001). Daily QA-MR detector array beam measurement results including output, symmetry, beam quality and field size were -0.11%±0.20%, -0.10%±0.19%, -0.01%±0.08%, (0.4±0.1) mm and (0.2±0.1) mm, respectively. The new process saved 25% (approximately 9 min) of the time compared to the standard process. Conclusions:The new daily QA process for MR-linac is performed based on self-developed phantom and Daily QA-MR detector array. The accuracy and sensitivity meet the requirements and can improve the QA efficiency.

In the field of healthcare service,it is crucial to optimize medical innovation services by combining the preferences of health service providers and demanders(i.e.,stakeholders).The best-worst scaling(BWS)method is a recently developed stated preference method for assessing preferences with distinctive advantages.Nevertheless,there is a lack of a comprehensive introduction to stakeholder preference assessment using BWS,thus constraining its applications and promotion.This paper introduces the process of using BWS to assess service providers'preferences for the Shared Medical Appointment for diabetes(SMART),an integrated healthcare service of medicine and health management,in the hope of providing reference for researchers for promoting the use of BWS in implementation research.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.