Background and purpose:The ripple filter(RiFi)is a passive energy modulator used in particle beam therapy to broaden the Bragg peak.The 1D-RiFi features a wavy structure that can broaden a monoenergetic carbon ion beam to 3 mm,while the 2D-RiFi employs a two-dimensional groove structure to achieve a 6 mm beam broadening.This study aimed to evaluate the potential advantages of the 2D-RiFi over the 1D-RiFi in terms of dose distribution optimization,treatment efficiency,and organ at risk(OAR)dose control by comparing water phantom and clinical patient plans.Methods:Carbon ion treatment plans were designed for water phantoms and 20 patients using both 1D-RiFi and 2D-RiFi.The water phantom plans targeted a cubic region of interest(80 mm×80 mm×80 mm)at ranges of 95,105,190 and 290 mm.From patients who underwent carbon ion therapy at Shanghai Proton and Heavy Ion Center,20 cases were selected via simple random sampling with computer-generated random numbers,stratified by the proportion of different tumor sites(6 head and neck tumors,4 prostate tumors,4 lung tumors,2 pancreatic tumors,2 liver tumors and 2 shoulder tumors).Key dosimetric metrics,including homogeneity index(HI),conformity index(CI)and clinical target volume(CTV)coverage by 95%prescription dose(V95),were analyzed along with OAR doses.Energy layers,beam time,and irradiation time were compared between the two RiFi types.Statistical analysis was performed using the Wilcoxon rank-sum test,with a significance level of P＜0.05.This study was approved by the ethics committee of Shanghai Proton and Heavy Ion Center(approval number:240311EXP-01).Results:For water phantom plans,the 1D-RiFi plans achieved HI of 0.04±0.01,CI of 1.10±0.03,V95 of 99.92%±0.06%and flatness of 6.52%±0.61%,while the 2D-RiFi plans achieved HI of 0.04±0.01,CI of 1.11±0.04,V95 of 99.92%±0.06%,and flatness of 7.52%±0.81%.The mean doses to the distal and lateral block in 1D-RiFi plans were(1.34 Gy±0.43)Gy[relative biological effectiveness(RBE)]and(0.98±0.05)Gy(RBE),respectively,compared to(1.47±0.33)Gy(RBE)and(0.94±0.03)Gy(RBE)for 2D-RiFi plans.The use of 2D-RiFi reduced the average beam-on time by 43%and the number of energy layers by 48%.For clinical plans,the 1D-RiFi plans had HI of 0.07±0.04,CI of 1.94±0.67,and V95 of 98.81%±1.61%,compared to HI of 0.07±0.05,CI of 1.95±0.70,and V95 of 98.79%±1.69%for the 2D-RiFi plans,with no statistically significant differences(P=0.77,0.65 and 0.66,respectively).OAR mean doses increased slightly with the 2D-RiFi plans(average increase of 0.8%,P=0.62)but remained within clinically acceptable limits.The 2D-RiFi plans reduced energy layers by 45%-50%(average 48%),beam time by 32%-49%(average 44%),and irradiation time by 28%-41%(average 36%).Conclusion:Treatment plans using the 2D-RiFi achieved comparable target coverage to those using the 1D-RiFi,with a slight but clinically acceptable increase in OAR doses.The application of the 2D-RiFi significantly reduced the number of energy layers,beam time and irradiation time in carbon ion therapy,enhancing treatment efficiency.

Objective To explore the feasibility and clinical value of endoscopic resection of duodenal papilla tumors with a maximum diameter greater than 3 cm. Methods A retrospective analysis was conducted on the clinical data of all 12 patients who underwent endoscopic resection of duodenal papilla tumors at the Endoscopy Center of Zhongshan Hospital (Xuhui Hospital), Fudan University and Rongcheng Hospital of Traditional Chinese Medicine from September 2017 to May 2023. The size of the tumors all exceeded 3 cm. Results All 12 patients successfully completed the operation, with a complete resection rate of 91.7% (11/12) and an en-bloc resection rate of 91.7% (11/12). One patient experienced delayed bleeding due to unclosed wound during operation and received endoscopic hemostasis; 11 cases underwent partial wound closure operation with pancreatic and biliary stent placement, without perforation or postoperative stenosis. Among them, 2 cases (18.2%) experienced delayed bleeding and received endoscopic hemostasis treatment. After operation, 1 case (8.3%) experienced nausea, vomiting, upper abdominal discomfort, and elevated blood amylase levels, who was later treated conservatively. During the mean follow-up period of 30.5 (1.0-69.0) months, 1 patient experienced recurrence and underwent surgical resection. Conclusions Endoscopic resection of duodenal papilla tumors can treat large diameter duodenal papilla tumors exceeding 3 cm, but postoperative complications may occur and require special attention. Postoperative placement of pancreatic and biliary stents and wound closure may reduce the incidence of complications.

OBJECTIVE To compare the efficacy of ceftazidime and avibactam （CZA） monotherapy and combination therapy in the treatment of carbapenem-resistant Gram-negative bacteria （CRGNB） infections， and analyze the influencing factors. METHODS The data of patients with CRGNB infection who received CZA treatment from January 2020 to March 2025 were collected retrospectively. The patients were divided into the CZA monotherapy group （52 cases） and the CZA combination therapy group （85 cases） according to treatment regimen. The therapeutic effects of the two groups were compared， and the drug susceptibility results of isolated strains were recorded. The multivariate Logistic regression model was used to analyze the factors influencing clinical efficacy of CRGNB patients. RESULTS The bacterial clearance rate of patients was significantly higher in the CZA combination therapy group than in the CZA monotherapy group （P＝0.012）. However， when comparing the 30-day mortality rate and the clinical response rate between the two groups， no statistically significant differences were observed （P＞0.05）. Among the isolates， carbapenem-resistant Klebsiella pneumoniae had the highest sensitivity to tigecycline （87.3%） and carbapenem-resistant Pseudomonas aeruginosa showed 90.9% sensitivity to amikacin. Five isolates were resistant to CZA. The multivariate Logistic regression showed， lung infection， receiving continuous renal replacement therapy （CRRT）， and inadequate treatment courses were significantly correlated with clinical treatment failure （P＜0.05）. CONCLUSIONS For CRGNB infection， the clinical efficacy of CZA combination therapy is similar to that of monotherapy， but the combination therapy has a higher bacterial clearance rate. Lung infections， receiving CRRT and inadequate treatment courses （No. are independent risk factors for clinical treatment failure.

Objective To investigate the in vitro antiviral effects of Blumea balsamifera(L.)DC.extract against Coxsackievirus B5(CVB5).Methods A series of dilutions of Coxsackievirus were prepared and co-cultured with RD cells to determine the TCID50 value.Subsequently,different concentrations of the extract were added to a 96-well plate containing RD cells to evaluate their impact on cell viability.The ability of Blumea balsamifera extract to inhibit Coxsackievirus was further observed in the 96-well plate containing RD cells and the extract.Results The TCID50 value of Coxsackie virus solution was 10-7.67.The inhibition rate of Blumea balsamifera extract against Coxsackievirus increased with concentration,with an IC50 value of 7.26 mg/L.At a concen-tration of 50 mg/L,the extract caused a decrease in RD cell viability(P＜0.05),but within the concentration range of 6.25 to 50 mg/L,it increased the viability of virus-infected RD cells(P＜0.05),with a selectivity index(SI)exceeding 6.89.Conclusion Blumea balsamifera(L.)DC.extract exhibits in vitro activity against Coxsackievirus.

Background and purpose:The ripple filter(RiFi)is a passive energy modulator used in particle beam therapy to broaden the Bragg peak.The 1D-RiFi features a wavy structure that can broaden a monoenergetic carbon ion beam to 3 mm,while the 2D-RiFi employs a two-dimensional groove structure to achieve a 6 mm beam broadening.This study aimed to evaluate the potential advantages of the 2D-RiFi over the 1D-RiFi in terms of dose distribution optimization,treatment efficiency,and organ at risk(OAR)dose control by comparing water phantom and clinical patient plans.Methods:Carbon ion treatment plans were designed for water phantoms and 20 patients using both 1D-RiFi and 2D-RiFi.The water phantom plans targeted a cubic region of interest(80 mm×80 mm×80 mm)at ranges of 95,105,190 and 290 mm.From patients who underwent carbon ion therapy at Shanghai Proton and Heavy Ion Center,20 cases were selected via simple random sampling with computer-generated random numbers,stratified by the proportion of different tumor sites(6 head and neck tumors,4 prostate tumors,4 lung tumors,2 pancreatic tumors,2 liver tumors and 2 shoulder tumors).Key dosimetric metrics,including homogeneity index(HI),conformity index(CI)and clinical target volume(CTV)coverage by 95%prescription dose(V95),were analyzed along with OAR doses.Energy layers,beam time,and irradiation time were compared between the two RiFi types.Statistical analysis was performed using the Wilcoxon rank-sum test,with a significance level of P＜0.05.This study was approved by the ethics committee of Shanghai Proton and Heavy Ion Center(approval number:240311EXP-01).Results:For water phantom plans,the 1D-RiFi plans achieved HI of 0.04±0.01,CI of 1.10±0.03,V95 of 99.92%±0.06%and flatness of 6.52%±0.61%,while the 2D-RiFi plans achieved HI of 0.04±0.01,CI of 1.11±0.04,V95 of 99.92%±0.06%,and flatness of 7.52%±0.81%.The mean doses to the distal and lateral block in 1D-RiFi plans were(1.34 Gy±0.43)Gy[relative biological effectiveness(RBE)]and(0.98±0.05)Gy(RBE),respectively,compared to(1.47±0.33)Gy(RBE)and(0.94±0.03)Gy(RBE)for 2D-RiFi plans.The use of 2D-RiFi reduced the average beam-on time by 43%and the number of energy layers by 48%.For clinical plans,the 1D-RiFi plans had HI of 0.07±0.04,CI of 1.94±0.67,and V95 of 98.81%±1.61%,compared to HI of 0.07±0.05,CI of 1.95±0.70,and V95 of 98.79%±1.69%for the 2D-RiFi plans,with no statistically significant differences(P=0.77,0.65 and 0.66,respectively).OAR mean doses increased slightly with the 2D-RiFi plans(average increase of 0.8%,P=0.62)but remained within clinically acceptable limits.The 2D-RiFi plans reduced energy layers by 45%-50%(average 48%),beam time by 32%-49%(average 44%),and irradiation time by 28%-41%(average 36%).Conclusion:Treatment plans using the 2D-RiFi achieved comparable target coverage to those using the 1D-RiFi,with a slight but clinically acceptable increase in OAR doses.The application of the 2D-RiFi significantly reduced the number of energy layers,beam time and irradiation time in carbon ion therapy,enhancing treatment efficiency.

Objective To explore the effects of intravenous thrombolysis combined with Solitaire FR stent thrombectomy on vascular recanalization,neurologic function and prognosis in patients with acute cerebral infarction(ACI)due to large artery occlusion(LAO).Methods A total of 172 patients with ACI-LAO treated in our department between October 2020 and March 2023 were retrospectively enrolled.According to treatment regimens,they were assigned into control group(86 cases,alteplase intravenous thrombolysis)and study group(86 cases,alteplase intravenous thrombolysis combined with Solitaire FR stent thrombectomy).Vascular recanalization,neurolog-ic function,cerebral perfusion and occurrence of adverse events were compared between the two groups.After 90 d of follow-up,their prognosis was evaluated with modified Rankin scale.Results There was no significant difference in success rate of vascular recanalization between the two group(P＞0.05),but complete recanalization rate was statistically higher in the study group than the control group(68.60％vs 50.00％,P＜0.05).The study group had obviously lower NHISS scores at 7 and 14 d after treatment,higher cerebral blood volume and cerebral blood flow,but shorter mean transit time when compared with the control group(P＜0.05,P＜0.01).No notable difference was observed in the total incidence of adverse events between them(P＞0.05).After 90 d of follow-up,the proportion of good prognosis was higher in the study group than the control group(80.23％vs 63.95％,P＜0.05).Conclusion Intravenous thrombolysis combined with Soli-taire FR stent thrombectomy shows better efficacy in ACI-LAO patients,with better vascular re-canalization and great improvements in neurologic function and prognosis.

Objective To analyze the values of renal resistance index(RRI),cystatin C(CysC),blood β2-microglobulin(β2-MG)and urinary N-acetyl-β-glucosamine glycosidase(NAG)in early prediction of contrast-induced acute kidney injury(CI-AKI).Methods A retrospective cohort analysis on 207 postoperative patients after intervention therapy was conducted.The patients were divided into AKI group(18 patients)and non-AKI group(189 patients)based on whether CI-AKI occurred.General and clinical data were collected and compared.Accord-ing to the time of diagnosis of AKI(D0 on the day of surgery or D1 on the first day after surgery),the AKI group was divided into AKI(D0)group and AKI(D1)group.Indicators RRI,CysC,and blood β2-MG,serum creatinine(sCr),and urinary NAG were compared between the two groups.The risk factors of CI-AKI were explored using logistic regression and linear regression.Results In the AKI group,males,preoperative sCr,acute physiological and chronic health(APACHⅡ)score and sequential organ failure(SOFA)score,surgical duratrion,sCr,CysC,blood β2-MG,urinary NAG on the day of surgery and the first day after surgery,and RRI were higher than those in the non-AKI group;Higher APACHEⅡ and SOFA scores and higher CysC level on D1 were independent risk factors for the occurrence of CI-AKI(P<0.05).Levels of CysC and urinay NAG on D0 were higher in the AKI(D0)group than in the AKI(D1)group(P<0.05).RRI,urinary NAG and blood β2-MG were not independent risk factors for CI-AKI.Conclusions CysC and urinary NAG are powerful predictors for the prediction of CI-AKI,and RRI and blood β2-MG cannot predict the occurrence of CI-AKI early.

Objective To observe the effect of calcified lymph nodes on video-assisted thoracoscopic surgery (VATS) lobectomy in the chronic obstructive pulmonary disease (COPD) patients with lung cancer. Methods A retrospective analysis was conducted on the COPD patients with lung cancer who underwent VATS lobectomy in the Department of Thoracic Surgery in the First Affiliated Hospital of Hebei North University from May 2014 to May 2018.The patients were assigned into a calcified lymph node group and a control group according to the presence or absence of calcified lymph nodes in CT,and the size,morphology,and calcification degree of the lymph nodes were recorded.The operation duration,intraoperative blood loss,chest tube retention time,hospitalization days,and overall complication rate were compared between the two groups. Results The 30 patients in the calcified lymph node group included 17 patients with one calcified lymph node and 13 patients with two or more calcified lymph nodes,and a total of 65 calcified lymph nodes were recorded.The calcified lymph nodes with the size ≤5 mm were the most common (53.8%),and complete calcification was the most common form (55.4%) in lymph node calcification.The mean operation duration had no significant difference between the calcified lymph node group and the control group (t=-1.357,P=0.180).The intraoperative blood loss (t=-2.646,P=0.010),chest tube retention time (t=-2.302,P=0.025),and hospitalization days (t=-2.274,P=0.027) in the calcified lymph node group were higher than those in the control group. Conclusion Calcified lymph nodes increase the difficulty and risk of VATS lobectomy in the COPD patients with lung cancer.The findings of this study are conducive to predicting the perioperative process of VATS lobectomy.
Humans ; Blood Loss, Surgical ; Retrospective Studies ; Lung Neoplasms/surgery* ; Pulmonary Disease, Chronic Obstructive ; Calcinosis ; Lymph Nodes

Objective: To investigate a SARS-CoV-2 epidemic reported in Rongcheng City, Weihai, Shandong Province. Methods: The SARS-CoV-2 nucleic acid positive patients and their close contacts were investigated, and the whole genome sequencing and genetic evolution analysis of 9 variant viruses were carried out. An infection source investigation and analysis were carried out from two sources of home and abroad, and three aspects of human, material and environment. Results: A total of 15 asymptomatic infections were reported in this epidemic, including 13 cases as employees of workshop of aquatic products processing company, with an infection rate of 21.67% (13/60). Two cases were infected people's neighbors in the same village (conjugal relation). The first six positive persons were processing workers engaged in the first process of removing squid viscera in the workshop of the company. The nucleic acid Ct value of the first time were concentrated between 15 and 29, suggesting that the virus load was high, which was suspected to be caused by one-time homologous exposure. The whole genome sequence of 9 SARS-CoV-2 strains was highly homologous, belonging to VOC/Gamma (Lineage P.1.15). No highly homologous sequences were found from previous native and imported cases in China. It was highly homologous with the six virus sequences sampled from May 5 to 26, 2021 uploaded by Chile. The infection source investigation showed that the company had used the squid raw materials captured in the ocean near Chile and Argentina from May to June 2021 over the last 14 days. Many samples of raw materials, products and their outer packages in the inventory were tested positive for nucleic acid. Conclusion: This epidemic is the first local epidemic caused by the VOC/Gamma of SARS-CoV-2 in China. It is speculated that the VOC/Gamma, which was prevalent in South America from May to June 2021, could be imported into China through frozen squid.
Humans ; SARS-CoV-2 ; COVID-19 ; Epidemics ; China/epidemiology*

Objectives:To analyze the allocation of mental health resources in Chinese mainland and the change of these resources during the 13 th Five-year Mental Health Plan period. This analysis will serve as evidence for developing future national mental health prevention and control policies. Methods:The National Mental Health Program Office created one questionnaire to survey available mental health facilities by the end of 2020. Descriptive methods were used to analyze the mental health facilities, psychiatric beds, and mental health professionals from type, sponsor, administrative level, regions, and sub-specialities.Results:By the end of 2020, 5 936 facilities were providing mental health services in Chinese mainland. 798 191 psychiatric beds (5.65 beds/10 000 persons), 50 124 psychiatrists (3.55/100 000 persons), and 139 642 registered nurses (9.89/100 000 persons) were located in these facilities. Of all these 5 936 mental health facilities, 649 (1.09%) had geriatric psychiatric wards, 312 (0.53%) had child psychiatric wards, and 1 548 (26.08%) had rehabilitation departments. 350 counties (12.31%) had no mental health facilities and 883 counties (31.05%) had no psychiatric beds in Chinese mainland, mainly in the mid-western regions. The numbers of psychiatric beds, psychiatrists, and registered nurses per unit land area in the western region were about 4 times lower than those in the middle region and 7-11 times lower than those in the eastern region.Conclusions:The mental health resources in Chinese mainland increased significantly from 2015 to 2020, but there are still the problems of uneven geographical allocation of resources and lagged sub-specialities development. While formulating the construction and development plan for mental health prevention and control system in the future, we should further develop the mental health resources at the county level, and vigorously support to establish of mental health sub-specialities for the elderly and children, as well as mental health rehabilitation, particularly in the mid-western regions.