Objective:To apply statistical process control (SPC) techniques to the quality assurance of non-normal radiotherapy plans through Johnson transformation, establishing patient-specific tolerance and action limits based on treatment sites and dose/distance assessment criteria, thereby enhancing the intensity-modulated radiation therapy (IMRT) verification accuracy and dose delivery precision.Methods:In this study, 951 gamma analysis data of patient-specific quality assurance (PSQA) executed on the Halcyon accelerator platform were selected and categorized into six groups based on treatment sites, including brain (102 cases), head and neck (100 cases), breast (229 cases), lung (154 cases), esophagus (223 cases), and pelvic (143 cases) groups. The six groups of data were statistically analyzed through Anderson-Darling normality tests ( α = 0.05) using Minitab 21 software. Non-normal data were transformed into normal data through Johnson transformation and then were used to establish treatment site-specific tolerance and action limits, which were compared with the Shewhart control charts based on normal distributions. Results:The PSQA result of the six groups all exhibited non-normal distributions ( P < 0.05). Through Johnson transformation, the tolerance and action limits for the head and neck, breast, lung, esophagus, and pelvic areas under the 3%/2 mm criterion ranged from 95.13% to 96.16% and 94.19% to 95.91%, respectively. In contrast, the tolerance and action limits ranged from 91.15% to 94.86% and 89.94% to 94.78% under the 2%/2 mm criterion. Directly applying Shewhart control charts without normality assumptions yielded higher tolerance limits compared to the application of Johnson transformation, increasing the false positive rate in the non-normal PSQA process. Conclusions:Applying the SPC techniques directly to a non-normal process can lead to an increased false alarm rate and wrong process interpretation. The SPC techniques combined with Johnson transformation enable more effective monitoring of a non-normal PSQA process, facilitating timely identification of potential factors that may lead to an out-of-control process based on the treatment site-specific limits.

In view of the few studies on the influence of Armillaria spp. infection on the content of the chemical components in different parts of Polyporus umbellatus sclerotia, this study determined the biomass of P. umbellatus sclerotia and the contents of ergosterol, polyporusterone A, polyporusterone B and polysaccharide in the separated cavity wall of the sclerotia and the uninfected part of the sclerotia in different harvesting years under the conditions of A. gallica and A. mellea infection respectively. According to the difference of content and dynamic changes of the polysaccharide and the steroid substances, the superior Armillaria sp. was screened to obtain the best harvest years of P. umbellatus. Using HPLC and UV-VIS spectrophotometry methods, the contents of ergosterol, polyporusterone A, polyporusterone B and polysaccharide in P. umbellatus sclerotia infected by the two Armillaria spp. in different years were determined. In addition, the differentially expressed genes related to P. umbellatus polysaccharide synthesis were screened according to the transcriptomic data of different parts of P. umbellatus after A. mellea infection. With the increase of years, the biomass of sclerotia infected by different Armillaria spp. had significant differences, and there were significant differences in the four components of sclerotia. The four components of the separated cavity wall of the sclerotia were significantly higher than those of the uninfected part. The best harvest time was the third year after cultivation. Transcriptomic analysis showed that the infection of Armillaria spp. could significantly promote polysaccharide synthesis, which provided a basis for polysaccharide content determination at the molecular level. The study clarified the influence of different Armillaria spp. infection on the accumulation of chemical components of P. umbellatus sclerotia, laying a foundation for exploring the symbiosis mechanism and provided a scientific clue for screening superior Armillaria sp. and guiding the artificial cultivation of P. umbellatus sclerotia.

Objective:To explore the related factors and independent risk factors of radiation pneumonitis (RP) in breast cancer patients after radiotherapy, and to guide the optimization of treatment plan for BC and reduce the incidence of RP.Methods:A retrospective analysis was conducted on 770 female breast cancer patients who received postoperative radiotherapy at Deyang People's Hospital between July 2021 and September 2024. The occurrence of RP was observed, and potential clinical and dosimetric factors were analyzed. Continuous variables were assessed using the t-test, categorical variables with the chi-square test, and univariate analysis was used to identify factors associated with RP. Multivariate logistic regression analysis was used to find out the independent risk factors of RP, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of each factor. Results:Among 770 patients, 46 developed RP (34 grade 1, 12 grade 2). Univariate analysis showed that surgical method, chemotherapy regimen, interval between chemotherapy and radiotherapy, age, planning target volume, and maximum dose of the ipsilateral lung were not associated with RP (all P>0.05). Clinical stage ( χ2=7.84, P=0.020), chest wall + supraclavicular + internal mammary lymph node irradiation ( χ2=104.50, P<0.001), supraclavicular + internal mammary lymph node irradiation ( χ2=8.90, P=0.003), number of chemotherapy cycles ( t=9.88, P<0.001), and ipsilateral lung V 5 Gy( t=16.47, P<0.001), V 10 Gy( t=18.70, P<0.001), V 15 Gy( t=20.23, P<0.001), V 20 Gy( t=23.39, P<0.001), V 25 Gy( t=21.68, P<0.001), V 30 Gy( t=21.67, P<0.001), V 35 Gy( t=20.67, P<0.001), V 40 Gy( t=19.96, P<0.001), V 45 Gy( t=18.59, P<0.001), V 50 Gy( t=11.69, P<0.001), D mean( t=30.76, P<0.001) were significantly correlated with the occurrence of RP. Multivariate analysis revealed that ipsilateral lung V 5 Gy ( OR=1.258, 95% CI: 1.143-1.384, P<0.001), number of chemotherapy cycles ( OR=2.767, 95% CI: 1.781-4.299, P<0.001), and chest wall + supraclavicular + internal mammary lymph node irradiation ( OR=7.926, 95% CI: 2.943-21.349, P<0.001) were independent risk factors for RP. Using V 5 Gy=51.65% as the diagnostic cutoff, the sensitivity and specificity for predicting RP were 0.870 and 0.804, respectively. Taking the number of chemotherapy cycles=6.50 as the cutoff, the sensitivity and specificity of predicting RP were 0.891 and 0.586, respectively. Taking 0.50 as the diagnostic cutoff point, the sensitivity and specificity of chest wall + supraclavicular + internal mammary lymph node irradiation for RP were 0.870 and 0.797, respectively. Conclusions:The number of chemotherapy cycles, ipsilateral lung V 5 Gy, and chest wall + supraclavicular + internal mammary lymph node irradiation are independent risk factors for RP in postoperative female breast cancer patients.

Objective:To apply statistical process control (SPC) techniques to the quality assurance of non-normal radiotherapy plans through Johnson transformation, establishing patient-specific tolerance and action limits based on treatment sites and dose/distance assessment criteria, thereby enhancing the intensity-modulated radiation therapy (IMRT) verification accuracy and dose delivery precision.Methods:In this study, 951 gamma analysis data of patient-specific quality assurance (PSQA) executed on the Halcyon accelerator platform were selected and categorized into six groups based on treatment sites, including brain (102 cases), head and neck (100 cases), breast (229 cases), lung (154 cases), esophagus (223 cases), and pelvic (143 cases) groups. The six groups of data were statistically analyzed through Anderson-Darling normality tests ( α = 0.05) using Minitab 21 software. Non-normal data were transformed into normal data through Johnson transformation and then were used to establish treatment site-specific tolerance and action limits, which were compared with the Shewhart control charts based on normal distributions. Results:The PSQA result of the six groups all exhibited non-normal distributions ( P < 0.05). Through Johnson transformation, the tolerance and action limits for the head and neck, breast, lung, esophagus, and pelvic areas under the 3%/2 mm criterion ranged from 95.13% to 96.16% and 94.19% to 95.91%, respectively. In contrast, the tolerance and action limits ranged from 91.15% to 94.86% and 89.94% to 94.78% under the 2%/2 mm criterion. Directly applying Shewhart control charts without normality assumptions yielded higher tolerance limits compared to the application of Johnson transformation, increasing the false positive rate in the non-normal PSQA process. Conclusions:Applying the SPC techniques directly to a non-normal process can lead to an increased false alarm rate and wrong process interpretation. The SPC techniques combined with Johnson transformation enable more effective monitoring of a non-normal PSQA process, facilitating timely identification of potential factors that may lead to an out-of-control process based on the treatment site-specific limits.

Objective:To explore the related factors and independent risk factors of radiation pneumonitis (RP) in breast cancer patients after radiotherapy, and to guide the optimization of treatment plan for BC and reduce the incidence of RP.Methods:A retrospective analysis was conducted on 770 female breast cancer patients who received postoperative radiotherapy at Deyang People's Hospital between July 2021 and September 2024. The occurrence of RP was observed, and potential clinical and dosimetric factors were analyzed. Continuous variables were assessed using the t-test, categorical variables with the chi-square test, and univariate analysis was used to identify factors associated with RP. Multivariate logistic regression analysis was used to find out the independent risk factors of RP, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of each factor. Results:Among 770 patients, 46 developed RP (34 grade 1, 12 grade 2). Univariate analysis showed that surgical method, chemotherapy regimen, interval between chemotherapy and radiotherapy, age, planning target volume, and maximum dose of the ipsilateral lung were not associated with RP (all P>0.05). Clinical stage ( χ2=7.84, P=0.020), chest wall + supraclavicular + internal mammary lymph node irradiation ( χ2=104.50, P<0.001), supraclavicular + internal mammary lymph node irradiation ( χ2=8.90, P=0.003), number of chemotherapy cycles ( t=9.88, P<0.001), and ipsilateral lung V 5 Gy( t=16.47, P<0.001), V 10 Gy( t=18.70, P<0.001), V 15 Gy( t=20.23, P<0.001), V 20 Gy( t=23.39, P<0.001), V 25 Gy( t=21.68, P<0.001), V 30 Gy( t=21.67, P<0.001), V 35 Gy( t=20.67, P<0.001), V 40 Gy( t=19.96, P<0.001), V 45 Gy( t=18.59, P<0.001), V 50 Gy( t=11.69, P<0.001), D mean( t=30.76, P<0.001) were significantly correlated with the occurrence of RP. Multivariate analysis revealed that ipsilateral lung V 5 Gy ( OR=1.258, 95% CI: 1.143-1.384, P<0.001), number of chemotherapy cycles ( OR=2.767, 95% CI: 1.781-4.299, P<0.001), and chest wall + supraclavicular + internal mammary lymph node irradiation ( OR=7.926, 95% CI: 2.943-21.349, P<0.001) were independent risk factors for RP. Using V 5 Gy=51.65% as the diagnostic cutoff, the sensitivity and specificity for predicting RP were 0.870 and 0.804, respectively. Taking the number of chemotherapy cycles=6.50 as the cutoff, the sensitivity and specificity of predicting RP were 0.891 and 0.586, respectively. Taking 0.50 as the diagnostic cutoff point, the sensitivity and specificity of chest wall + supraclavicular + internal mammary lymph node irradiation for RP were 0.870 and 0.797, respectively. Conclusions:The number of chemotherapy cycles, ipsilateral lung V 5 Gy, and chest wall + supraclavicular + internal mammary lymph node irradiation are independent risk factors for RP in postoperative female breast cancer patients.

Objective To investigate the incidence rate,clinical characteristics,and prognosis of neonatal stroke in Shenzhen,China.Methods Led by Shenzhen Children's Hospital,the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022.The incidence,clinical characteristics,treatment,and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137,1/6 060,and 1/7 704,respectively.Ischemic stroke accounted for 75％(27/36);boys accounted for 64％(23/36).Among the 36 neonates,31(86％)had disease onset within 3 days after birth,and 19(53％)had convulsion as the initial presentation.Cerebral MRI showed that 22 neonates(61％)had left cerebral infarction and 13(36％)had basal ganglia infarction.Magnetic resonance angiography was performed for 12 neonates,among whom 9(75％)had involvement of the middle cerebral artery.Electroencephalography was performed for 29 neonates,with sharp waves in 21 neonates(72％)and seizures in 10 neonates(34％).Symptomatic/supportive treatment varied across different hospitals.Neonatal Behavioral Neurological Assessment was performed for 12 neonates(33％,12/36),with a mean score of(32±4)points.The prognosis of 27 neonates was followed up to around 12 months of age,with 44％(12/27)of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke,often with convulsions as the initial presentation,involvement of the middle cerebral artery,sharp waves on electroencephalography,and a relatively low neurodevelopment score.Symptomatic/supportive treatment is the main treatment method,and some neonates tend to have a poor prognosis.

AIM To explore the effects of Buyang Huanwu Decoction on mitochondrial oxidative damage and PKCε-Nampt pathway in rats following cerebral ischemia reperfusion(I/R).METHODS The rats were randomly divided into the sham operation group,the model group,Buyang Huanwu Decoction group(14.3 g/kg)and edaravone group(3 mg/kg).Except those of the sham operation group,SD rats of other groups were induced into models of brain I/R injury by MCAO method,followed by corresponding drug administration 24 hours after operation.After 7 days of administration,the rats had their neurological deficit evaluated by neurological function scoring;thier expression of neuron marker MAP-2 detected by immunofluorescence staining;their neuron damage observed and the oxidative damage evaluated through assessment of their ROS levels and MDA and SOD activities;their changes of mitochondrial membrane potential detected by fluorescent probe JC-1;their ratio of NAD+/NADH detected using modified enzyme circulation method;their expressions of PKCε,p-PKCε and Nampt proteins detected with Western blot;and their positive expressions of p-PKCε and Nampt proteins detected with immunohistochemistry method.RESULTS Compared with the model group,Buyang Huanwu Decoction group shared decreased cerebral infarction volume and neurological function score(P<0.05);increased cerebral fluorescence intensity of MAP-2(P<0.05);reduced neuronal damage,decreased cerebral levels of ROS and MDA(P<0.05);increased SOD activity,mitochondrial membrane potential and NAD+/NADH ratio(P<0.05);and increased protein expressions of p-PKCε and Nampt(P<0.05).CONCLUSION Buyang Huanwu Decoction can improve mitochondrial function and reduce brain I/R injury in rats by activating their PKCε-Nampt signaling pathway.

Objective To investigate the protective effect and mechanism of acellular nerve allografts(ANA)combined with electroacupuncture on spinal ganglia in rats with sciatic nerve injury(SNI).Methods Totally 50 male adult SD rats were randomly selected for this experiment.Ten rats were prepared for the ANA.Forty male SD rats were randomly divided into normal group,model group,ANA group and combinational group,with 10 rats in each group.The SNI model was established by cutting off the nerves 10 mm at the 5 mm on the inferior border of piriformis after separating the right sciatic nerves.The rats in the ANA group were bridged with ANA to the two broken ends of injured nerves.The rats in the combinational group were treated with electroacupuncture 2 days after ANA bridging,Huantiao(GB30)and Yanglingquan(GB34)were performed as the acupuncture points,each electroacupuncture lasted 15 minutes and 7 days as a course of treatment,4 courses in all.Sciatic nerve conduction velocity was measured by electrophysiology to evaluate the regeneration of damaged axons.Morphology of spinal ganglia was observed by Nissl staining.The expression of nerve growth factor(NGF)and brain-derived neurotrophic factor(BDNF)were detected by Western blotting and immunofluorescent staining.Results Compared with the normal group,the sciatic nerve conduction velocity in model group decreased significantly(P<0.01),Nissl bodies in neurons of spinal ganglia were swollen and dissolved,with incomplete structure and the number decreased dramatically(P<0.01),while the level of NGF and BDNF also decreased significantly(P<0.01).Compared with the model group,the sciatic nerve conduction velocity in ANA and combinational groups strongly increased(P<0.01),the damage of Nissl bodies in neurons of spinal ganglia reduced and the number obviously increased(P<0.01),the level of NGF and BDNF increased considerably(P<0.01).Compared with the ANA group,the sciatic nerve conduction velocity in combinational group increased significantly(P<0.01),the morphology of Nissl bodies in neurons of spinal ganglia were more regular and the number increased(P<0.01),moreover,the level of NGF also increased significantly(P<0.01).Conclusion ANA combined with electroacupuncture can enhance the sciatic nerve conduction velocity,improve the morphology of neurons in spinal ganglia and play a protective effect on spinal ganglia.The mechanism can be related to the higher expression of NGF and BDNF proteins,especially the expression of NGF protein.

Purpose: This systematic review aimed to scrutinize the progression of symptom cluster research in adult cancer patients who received primary or adjuvant chemotherapy between 2001 and 2023, providing a comprehensive understanding of clinical practice and future research. Methods: PubMed, Ovid MEDLINE, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and Web of Science databases were searched for theme words and free words related to symptom clusters, cancer, and chemotherapy. Eligible studies were published between January 1, 2001, and May 30, 2023; adults who were diagnosed with cancer and received primary or adjuvant chemotherapy were evaluated. Results: Twenty-eight studies were included in this review. The Memorial Symptom Assessment Scale emerged as the predominant instrument and exploratory factor analysis was the most frequently employed statistical method to identify symptom clusters. Psychological, gastrointestinal, and physical image symptom clusters were the most commonly delineated. Furthermore, the temporal stability of the symptom clusters showed varying dynamics, with psychological symptom clusters displaying relative consistency over time. Conclusion Interventions are needed for the most common and stable symptoms in patients with cancer undergoing chemotherapy. Future endeavors may necessitate more longitudinal studies to delve deeper into the temporal stability and dynamic variations of symptom clusters. Such investigations hold promise for advancing symptom cluster research, elucidating the underlying mechanisms, and fostering the development of targeted interventions, thereby enriching the symptom management paradigm in oncological care.

Purpose: This systematic review aimed to scrutinize the progression of symptom cluster research in adult cancer patients who received primary or adjuvant chemotherapy between 2001 and 2023, providing a comprehensive understanding of clinical practice and future research. Methods: PubMed, Ovid MEDLINE, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and Web of Science databases were searched for theme words and free words related to symptom clusters, cancer, and chemotherapy. Eligible studies were published between January 1, 2001, and May 30, 2023; adults who were diagnosed with cancer and received primary or adjuvant chemotherapy were evaluated. Results: Twenty-eight studies were included in this review. The Memorial Symptom Assessment Scale emerged as the predominant instrument and exploratory factor analysis was the most frequently employed statistical method to identify symptom clusters. Psychological, gastrointestinal, and physical image symptom clusters were the most commonly delineated. Furthermore, the temporal stability of the symptom clusters showed varying dynamics, with psychological symptom clusters displaying relative consistency over time. Conclusion Interventions are needed for the most common and stable symptoms in patients with cancer undergoing chemotherapy. Future endeavors may necessitate more longitudinal studies to delve deeper into the temporal stability and dynamic variations of symptom clusters. Such investigations hold promise for advancing symptom cluster research, elucidating the underlying mechanisms, and fostering the development of targeted interventions, thereby enriching the symptom management paradigm in oncological care.