Objective To investigate the current distribution of radiotherapy resources in Gansu Province, evaluate the equity of resource allocation, and provide a scientific basis for optimizing regional resource allocation. Methods A questionnaire survey was carried out to assess radiotherapy resources in medical institutions across Gansu Province, China. The equity of radiotherapy resource distribution and associated disparities were assessed using the Gini coefficient, Lorenz curve, and Theil index. Results A total of 23 medical institutions in Gansu Province provided radiotherapy services, comprising 39 radiotherapy devices and 438 professionals, of whom medical physicists accounted for 16.9%. The radiotherapy frequency was 0.47 cases per thousand population. The Gini coefficients for radiotherapy resource distribution ranged from 0.38 to 0.56 by population and from 0.52 to 0.70 by geography. The Theil index for radiotherapy resources ranged from 1.36 to 3.67. Conclusion Radiotherapy resources in Gansu Province were insufficient, and the capacity of radiotherapy service was suboptimal. The equity of radiotherapy resource allocation by geography was worse than that by population. Therefore, it is imperative to address the shortage of radiotherapy resources, strengthen the professional workforce, enhance the capacity radiotherapy service and resource utilization, optimize resource allocation, and promote regional equity in radiotherapy provision in Gansu Province.

Objective: To analyze the association between alcohol consumption and lumbar disc herniation (LDH), so as to provide a reference for the development of prevention and treatment strategies for LDH. Methods: From May to July 2022, permanent residents aged ≥18 years from eight counties (cities/districts) in Gansu Province were selected using a multistage stratified random sampling method. Data on basic characteristics, alcohol consumption in the past 30 days, hypertension, and diabetes mellitus were collected through questionnaire surveys. LDH was determined based on imaging findings, combined with disease history or clinical symptoms. Multivariable logistic regression model was used to analyze the association between alcohol consumption and LDH, with subgroup analyses conducted by gender, age, ethnicity, and altitude of residence. Propensity score matching (PSM) was utilized for sensitivity analysis. Results: A total of 4 545 individuals were surveyed. There were 2 026 (44.58%) males and 2 519 (55.42%) females. The mean age was (44.82±15.33) years. The study participants were predominantly of Han ethnicity, with 2 598 persons accounting for 57.17%. The altitude of residence was mainly above 3 500 m, with 1 941 persons accounting for 42.71%. There were 574 alcohol drinkers, accounting for 12.63%. LDH was detected in 1 035 cases, with a detection rate of 22.77%. Multivariable logistic regression analysis showed that after adjusting for gender, age, physical activity, and hypertension, compared to non-drinking residents, alcohol-consuming residents exhibited a 27.6% reduction in the risk of LDH (OR=0.724, 95%CI: 0.544-0.963). No significant interaction effects on LDH risk were observed between alcohol consumption and gender, age, ethnicity, or altitude of residence (all Pfor interaction >0.05). The results of the sensitivity analysis indicated that compared to non-drinking residents, alcohol-consuming residents exhibited a 38.8% reduction in the risk of LDH (OR=0.612, 95%CI: 0.382-0.976). Conclusion Alcohol consumption was statistically associated with a lower risk of LDH.

Mycophenolic acid (MPA), the active moiety of both mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS), serves as a primary immunosuppressant for maintaining solid organ transplants. Therapeutic drug monitoring (TDM) enhances treatment outcomes through tailored approaches. This study aimed to develop an evidence-based guideline for MPA TDM, facilitating its rational application in clinical settings. The guideline plan was drawn from the Institute of Medicine and World Health Organization (WHO) guidelines. Using the Delphi method, clinical questions and outcome indicators were generated. Systematic reviews, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence quality evaluations, expert opinions, and patient values guided evidence-based suggestions for the guideline. External reviews further refined the recommendations. The guideline for the TDM of MPA (IPGRP-2020CN099) consists of four sections and 16 recommendations encompassing target populations, monitoring strategies, dosage regimens, and influencing factors. High-risk populations, timing of TDM, area under the curve (AUC) versus trough concentration (C₀), target concentration ranges, monitoring frequency, and analytical methods are addressed. Formulation-specific recommendations, initial dosage regimens, populations with unique considerations, pharmacokinetic-informed dosing, body weight factors, pharmacogenetics, and drug‍-‍drug interactions are covered. The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy, promoting standardization of MPA TDM, and enhancing treatment efficacy and safety.
Mycophenolic Acid/administration & dosage* ; Drug Monitoring/methods* ; Humans ; Organ Transplantation ; Immunosuppressive Agents/administration & dosage* ; Delphi Technique

OBJECTIVE To summarize the process of investigation,disposal and prevention of a cluster incident of post-operative incision infection following microtia plastic surgery in the otorhinolaryngology department of a terti-ary care hospital,in order to provide a basis for hospital-aquired infection prevention and control.METHODS An epidemiological survey was conducted on seven patients who underwent otorhinolaryngoplasty for microtia in the ENT department of a tertiary care hospital from 27 Jul.to 7 Sep.2023,and interventions were implemented.RESULTS The incidence rate of infection was 71.43％among post-otorhinolaryngoplasty patients.In 5 patients,area for electrocoagulation of haemostatic increased by approximately 50％compared to the previous period,and drainage tubes were left in the surgical area for 11 to 13 days.Patients changed dressings in a shared dressing room.Pseudomonas aeruginosa was detected in three of the infected patients,and their antibiotic sensitivity pat-terns were similar to that of a lower respiratory tract infection patient(case 0)in the same department.CONCLUSION Inadequate aseptic practice by medical staff,longer retention of drainage tubes,incomplete disin-fection of the environment of the dressing room,and changes in surgical procedures may be the primary factors contributing to the occurrence of this cluster of infections.

OBJECTIVE To investigate the current status of contamination with carbapenem-resistant gram-negative bacteria in environment of intensive care units(ICU)of tertiary hospitals in Shanghai and find out the potential contamination sources so as to provide bases for prevention and control of multidrug-resistant organisms infec-tions in the ICUs.METHODS The surroundings of the ICU patients detected with CRGNB and environmental ob-jects surfaces in public area were sampled by mSuperCARBA chromogenic media from Dec.2024 to Jan.2025,the strains were isolated,and the targeted strains were identified by matrix-assisted laser desorption/ionization time-of-flight(MALDI-TOF)mass spectrometer.RESULTS A total of 653 samples were collected in the survey,76 of which were positive for bacterial culture,60 were detected with CRGNB,and the isolation rate of CRGNB was 9.19％.The isolation rate of CRGNB was 53.40％in the water-source group,0.91％in the non-water-source group,and there was significant difference(x2=286.450,P＜0.001).The result of whole genome sequencing for 17 strains of CRKP showed that ST11 and ST15 were the two major types of multilocus typing(MT),respective-ly carrying 2-12 types of drug resistance genes.CONCLUSIONS The CRGNB strains are detected in some environ-mental sites of the ICUs of 15 tertiary hospitals in Shanghai,and the isolation rate of CRKP is highest among them.The colonization rate of CRGNB is relatively low on the highly frequent-contact object surfaces of the ICUs,however,sink drain holes poses a risk of hospital-acquired CRGNB infections transmissions.Additionally,the ba-sins and towels of the CRGNB patients are hard to be thoroughly cleaned,disinfected and dried,resulting in a high contamination rate.

Objective:To develop an artificial intelligence (AI)-based platelet review strategy to identify abnormal platelet histograms with no significant difference between initial impedance platelet count (PLT-I) and PLT-F results.Methods:This study included 5 119 routine blood analysis in Nanfang Hospital of Southern Medical University and its Ganzhou branch from July 2023 and March 2024. Specimens exhibiting abnormal platelet histograms and an initial platelet count >40×10?/L underwent review using the fluorescent platelet count (PLT-F) channel. Consistency of the results was defined as a difference between impedance platelet count (PLT-I) and PLT-F less than ±20% of the PLT-F results. A deep learning model was developed using platelet and red blood cell histogram data from a training set of 3 807 specimens. The model′s diagnostic performance was evaluated on an independent external validation set ( n=805) using receiver operating characteristic (ROC) curve analysis. Changes in the number of reviewed samples and sample turnaround time were analyzed to assess its clinical utility. Results:The deep learning model based on platelet and red blood cell histograms achieved an area under the ROC curve (AUC) of 0.854 in the training set. At a cutoff value of 0.1, the sensitivity was 0.954 and specificity was 0.358. The model could reduce review by 16.80% (190/1 131). In the validation set, the AUC was 0.805, with a sensitivity of 0.955 and specificity of 0.307, corresponding to a reduction of 17.41% (47/270) in reviewed specimens.Conclusion:The platelet review prediction model developed based on deep learning technology can efficiently identify samples with consistent results before and after review, reducing unnecessary reviews and shortening specimen testing time, thereby improving the efficiency of platelet test.

Objective:To evaluate the structural and functional changes of the left atrium in amateur ultra-marathon runners using ultrasound three-dimensional speckle tracking imaging technology.Methods:From June 2023 to June 2024，90 amateur marathon athletes were retrospectively recruited，including 44 amateur ultra-marathon（running distance ≥50 km）athletes（Ultra-marathon，UM group）and 46 amateur classic marathon（running distance<50 km）athletes（Marathon，M group）. Another 39 healthy volunteers who underwent physical examinations in Hangzhou Normal University Affiliated Hospital at the same time were selected as the control group. The distance，running age of amateur marathon runners were recorded. All subjects which underwent conventional echocardiography combined with three-dimensional speckle tracking echocardiography（3D-STE）obtained left atrial volume and functional parameters，including two-dimensional ultrasound indicators such as left atrial anterior posterior diameter（LAd），left ventricular end-diastolic diameter（LVEDd），left ventricular ejection fraction（LVEF），early diastolic peak velocity at the mitral valve orifice（E），and early diastolic peak velocity at the lateral mitral annulus（e'），E/e'，left atrial minimum，maximum，presystolic volumes（LAVmin，LAVmax，LAVpreA），left atrial maximum volume index（LAVImax），left atrial emptying volume（LAEV），overall left atrial ejection fraction，active and passive ejection fraction（LAEF，LAaEF，LApEF），left atrial expansion index（LAEI），left atrial reservoir period，conduit period，systolic long axis and circumferential strain（LASr，LAScd，LASct，LASr-c，LAScd-c，LASct-c）. The differences in left atrial parameters among three groups were compared and the relevant factors affecting LAEF were analyzed.Results:There were statistically significant differences in LAd，LVEDd，LAVmin，LAVmax，LAVpreA，LAVImax，and LAEV among the three groups（all P<0.05），and there were statistically significant differences in pairwise comparisons between the groups（all P<0.05）. Compared with the control group，LAEF，LApEF，LASr，LAScd，LASct，LASr-c，LAScd-c and LASct-c were significantly reduced in the M and UM groups（all P<0.05），while there were no statistically significant differences in these parameters between the UM and M groups（all P>0.05）；There were no statistically significant differences in IVSd，LVEF，E/e'，LAEI，and LAaEF among the 3 groups（all P>0.05）.There were no statistically significant differences in IVSd，LVEF，E/e'，LAaEF and LAEI among the 3 groups（all P>0.05）. Multiple linear regression analysis showed that only weekly running volume was an independent predictor of decreased LAEF in amateur marathon runners. The repeatability test indicated good consistency within and between observers. Conclusions:Amateur marathon runners have varying degrees of damage to their left atrial reservoir function，conduit function，and contraction function，with amateur ultra-marathon runners showing more significant damages，3D-STE technology can evaluate the structural and functional changes in the left atrium in amateur ultra-marathon athletes，and assist clinical understanding of atrial adaptation in amateur ultra- marathon athletes.

Objective:To summarize endorectal ultrasound（ERUS）findings of rectal lymphoma（RL）and evaluate its clinical value for preoperative diagnosis.Methods:Nine RL patients between Jan 2015 and March 2025 in the Sixth Affiliated Hospital of Sun Yat-Sen University were included in this retrospective study. ERUS findings including lesion location，size，echogenicity，mucosal integrity，depth of infiltration，and blood flow characteristics were reviewed. The diagnostic performance of ERUS was evaluated using pathology as the gold standard.Results:ERUS features of RL included extensive bowel wall involvement（≥1/2 circumference in 8/9 cases），intact mucosa（7/9），homogeneous markedly hypoechoic echogenicity（6/9），and Adler grade 3 blood flow（9/9）. No case presented bowel obstruction；three cases involved multi- segmental bowel. All four cases who received ultrasound-guided biopsy reached conclusive diagnosis，while 2 of them were infeasible for endoscopic biopsy.Conclusions:Typical ERUS findings of RL include extensive infiltration，preserved mucosa，and homogeneous markedly hypoechoic echogenicity. ERUS could clearly show the submucosal infiltration pattern and bowel wall layers，and significantly improve preoperative diagnostic accuracy in combination with ultrasound-guided biopsy.

Objective:To explore the value of endorectal echodefecography（EDF）in the evaluation of functional anorectal disorders（FAD）.Methods:A total of 67 patients clinically diagnosed with FAD who underwent EDF at the Sixth Affiliated Hospital of Sun Yat-Sen University from September 2021 to August 2024 were retrospectively collected. EDF was performed using a combination of transrectal and transperineal scans. XRD was used as the reference standard.Results:The diagnostic accuracy，sensitivity，specificity，positive predictive value，and negative predictive value of EDF for common FADs were as follows：for rectocele，85.1%，84.6%，85.4%，78.6%，and 89.7%；for rectal intussusception，79.1%，50.0%，93.3%，78.6%，and 79.2%；for external rectal prolapse，94.0%，71.4%，100%，100%，and 93.0%；for anismus，82.1%，66.7%，82.8%，15.4%，and 98.1%；for perineal descent，65.7%，54.2%，72.1%，52.0%，and 52.0%.Conclusions:EDF is valuable for evaluating FAD，especially for external rectal prolapse and rectocele. It can serve as an effective complement to XRD and provide a non-invasive and safe imaging method for FAD diagnosis.

Objective To observe the effect of tuina on glutamate content and synaptic ultrastructure in spinal dorsal horn of rats with chronic sciatic nerve compression injury;To explore the potential mechanism of tuina regulation of the SNAP25/VGLUT2 pathway in alleviating lumbar disc herniation.Methods A chronic sciatic nerve compression injury model was used to simulate neuropathic pain in lumbar disc herniation.24 SD rats were randomly divided into blank group,model group and tuina group,with 8 rats in each group.From the 4th day after modeling,the tuina group was intervened with the tuina method for 10 minutes once a day for 14 consecutive days.The paw withdrawal threshold(PWT)and paw withdrawal latency(PWL)of rats in each group on the day before modeling,and the 4th,10th,14th and 17th days after modeling were detected.The spinal cord tissue of the modeling side was taken,synaptic ultrastructure of spinal dorsal horn neurons was observed using transmission electron microscopy,immunofluorescence staining was used to detect the expression of NR2A in the spinal dorsal horn,Western blot was used to detect the expression of SNAP25 protein in the spinal dorsal horn,immunohistochemistry was used to detect the expression of VGLUT2 in the spinal dorsal horn,ELISA was used to detect the content of glutamate in the spinal dorsal horn.Results Compared with the blank group,PWT and PWL of the model group were significantly reduced on the 4th,10th,14th and 17th days after modeling(P<0.001),with accumulation of vesicles in the presynaptic membrane of the dorsal horn of the spinal cord,increase in the area of the postsynaptic dense zone,and enlargement of the synaptic cleft,while the protein expressions of NR2A,SNAP25 and VGLUT2 in the spinal dorsal horn increased(P<0.05,P<0.001),and the content of glutamate increased(P<0.001).Compared with the model group,PWT and PWL of the tuina group rats significantly increased on the 10th,14th and 17th days after modeling(P<0.001),synaptic vesicles were evenly distributed,the area of the postsynaptic dense zone decreased,and the synaptic cleft decreased,while the protein expressions of NR2A,SNAP25 and VGLUT2 in the spinal dorsal horn decreased(P<0.05,P<0.001),and the content of glutamate decreased(P<0.01).Conclusion Tuina may regulate the content of glutamate through the SNAP25/VGLUT2 pathway in the spinal dorsal horn,improve the synaptic ultrastructure of neurons,and have an analgesic effect on lumbar disc herniation.