To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

Objective To carry out cervical cancer VMAT radiotherapy planning respectively with the single-criteria optimization(SCO)and multi-criteria optimization(MCO)modes of Raystation 4.7 planning system,and to provide references for selecting optimization mode clinically by comparing and analyzing the dosimetric parameters such as target dose distribution,exposure dose to organ at risk(OAR),monitor unit and beam-on time.Methods Ten cervical cancer patients who attended some hospital from February to December 2022 were retrospectively selected,and some VMAT plans were designed for them with the SCO mode of Raystation 4.7 planning system and then enrolled into a SCO group;other VMAT plans were redesigned with the MCO mode under the premise the setup conditions such as machine model and shot field angle were unchanged,and divided into a MCO group.The two groups were compared in terms of maximum dose(D2%),minimum dose(D98%),homogeneity index(HI)and conformity index(CI)of the planning target volume(PTV),beam-on time,monitor unit and exposure doses to OARs including bladder V50 Gy,V40 Gy and V30 Gy,rectum V50 Gy,V40 Gy and V30 Gy,small intestine V50 Gy,V40 Gy and V30 Gy and left and right femur V50 Gy,V40 Gy and V30 Gy.SPSS 22.0 software was used for statistical analysis.Results Both the two groups met clinical requirements.There were no significant differences between the two groups in D98%,CI,small intestine V50 Gy and left and right femur V40 Gy(P>0.05).The MCO group had the values of HI,D2%,V50 Gy,V40 Gy and V30 Gy,rectum V50 Gy,V40 Gy and V30 Gy,small intestine V40 Gy and V30 Gy and left and right femur V30 Gy lower than those of the SCO group,with the differences being statistically significant(P<0.05).The SCO group had less monitor units and shorter beam-on time when compared with the MCO group,with the differences being statistically siginificant(P<0.05).Conclusion When compared with the SCO mode-based VMAT plans,the MCO mode-based VMAT plans significantly decrease the exposure doses and volume to rectum,bladder and small intestine and raise the PTV homogeneity,while lower the treatment efficiency to some extent by increased monitor units and prolonged beam-on time.[Chinese Medical Equipment Journal,2025,46(9):39-44]

Objective To carry out cervical cancer VMAT radiotherapy planning respectively with the single-criteria optimization(SCO)and multi-criteria optimization(MCO)modes of Raystation 4.7 planning system,and to provide references for selecting optimization mode clinically by comparing and analyzing the dosimetric parameters such as target dose distribution,exposure dose to organ at risk(OAR),monitor unit and beam-on time.Methods Ten cervical cancer patients who attended some hospital from February to December 2022 were retrospectively selected,and some VMAT plans were designed for them with the SCO mode of Raystation 4.7 planning system and then enrolled into a SCO group;other VMAT plans were redesigned with the MCO mode under the premise the setup conditions such as machine model and shot field angle were unchanged,and divided into a MCO group.The two groups were compared in terms of maximum dose(D2%),minimum dose(D98%),homogeneity index(HI)and conformity index(CI)of the planning target volume(PTV),beam-on time,monitor unit and exposure doses to OARs including bladder V50 Gy,V40 Gy and V30 Gy,rectum V50 Gy,V40 Gy and V30 Gy,small intestine V50 Gy,V40 Gy and V30 Gy and left and right femur V50 Gy,V40 Gy and V30 Gy.SPSS 22.0 software was used for statistical analysis.Results Both the two groups met clinical requirements.There were no significant differences between the two groups in D98%,CI,small intestine V50 Gy and left and right femur V40 Gy(P>0.05).The MCO group had the values of HI,D2%,V50 Gy,V40 Gy and V30 Gy,rectum V50 Gy,V40 Gy and V30 Gy,small intestine V40 Gy and V30 Gy and left and right femur V30 Gy lower than those of the SCO group,with the differences being statistically significant(P<0.05).The SCO group had less monitor units and shorter beam-on time when compared with the MCO group,with the differences being statistically siginificant(P<0.05).Conclusion When compared with the SCO mode-based VMAT plans,the MCO mode-based VMAT plans significantly decrease the exposure doses and volume to rectum,bladder and small intestine and raise the PTV homogeneity,while lower the treatment efficiency to some extent by increased monitor units and prolonged beam-on time.[Chinese Medical Equipment Journal,2025,46(9):39-44]

Objective:To investigate the influence of the complexity metrics of the multi-leaf collimator (MLC) on the γ-pass rate of volumetric modulated arc therapy (VMAT) plans for nasopharyngeal carcinoma (NPC).Methods:A total of 60 VMAT plans for NPC were selected to measure the γ-pass rate. The MLC data across all control points (CPs) in each VMAT plan were analyzed to calculate the mean field area (MFA), average leaf gap (ALG), small aperture score (SAS), and their corresponding weighted metrics including MFAW, ALGW, and SASW, considering dose weight (W). Pearson′s bivariate correlation analysis was conducted to examine the correlations between MLC complexity metrics and the γ-pass rate. Moreover, the receiver operating characteristic (ROC) analysis was employed to assess the predictive efficacy of MLC complexity metrics on dose verification result.Results:Under the 3%/3 mm, 3%/2 mm, and 2%/2 mm criteria, the MFA in the 60 VMAT plans exhibited a positive correlation with the γ-pass rate ( r=0.82, 0.79, 0.72, P<0.05), and the MFAW was also positively correlated with the γ-pass rate ( r=0.83, 0.81, 0.75, P<0.05). The ALG manifested a positive correlation with the γ-pass rate ( r=0.82, 0.79, 0.74, P<0.05), as did the ALGW ( r=0.83, 0.81, 0.77, P<0.05). The SAS(0-1 cm), SAS(1-2 cm), SAS(2-3 cm), and SAS(3-4 cm) displayed negative correlations with the γ-pass rate ( r= -0.86, -0.82, -0.71, -0.84, -0.82, -0.72, -0.79, -0.79, -0.73, -0.30, -0.35, -0.42, P<0.05), whereas the SAS(4-5 cm), SAS(5-6 cm), and SAS(6-40 cm) showed positive correlations with the γ-pass rate ( r=0.49, 0.45, 0.33, 0.73, 0.71, 0.59, 0.79, 0.79, 0.76, P<0.05). The outcomes of SASW reveal slightly stronger correlations than those of SAS. In terms of correlations among complexity metrics, a positive correlation was observed between MFA and ALG ( r=0.98, P<0.05). ALG was negatively correlated with SAS(0-1 cm), SAS(1-2 cm), SAS(2-3 cm), and SAS(3-4 cm) ( r= -0.95, -0.94, -0.89, -0.39, P<0.05), and positively correlated with SAS(4-5 cm), SAS(5-6 cm), and SAS(6-40 cm) ( r=0.51, 0.77, 0.92, P<0.05). The weighted result mirrored these correlations. The ROC-derived analytical result indicate that MFA, MFAW, ALG, ALGW, SAS(0-1 cm), SAS(1-2 cm), SAS(2-3 cm), SAS(6-40 cm), SASW(0-1 cm), SASW(1-2 cm), SASW(2-3 cm), and SASW(6-40 cm) demonstrated exceptional predictive efficacy for dose verification result [Area under the curve (AUC) > 0.9, P<0.05]. Conclusions:The γ-pass rate of VMAT plans for NPC is strongly correlated with MLC complexity metrics, which demonstrate excellent predictive efficacy for dose verification result. The increased uncertainty in dose calculations and measurements caused by narrow fields generated by the MLC is a significant factor contributing to the reduced γ-pass rate of VMAT plans. This finding is associated with discrepancies in the precision of treatment planning system (TPS) modeling and the accuracy of dose verification tools, providing a reference for similar challenges.

Objective:To investigate the differences in dosimetric parameters for target volumes and organs at risk (OARs), radiation doses to reconstructed tissues, and beam-on time in radiotherapy among helical tomotherapy (HT), volumetric modulated arc therapy (VMAT), and fixed-field intensity-modulated radiotherapy (F_IMRT) following immediate breast reconstruction for breast cancer, thereby providing a reference for the selection of clinical radiotherapy techniques.Methods:This study retrospectively investigated 15 breast cancer patients who underwent radiotherapy following modified radical mastectomy and immediate breast reconstruction at the Liuzhou Worker′s Hospital from August 2018 to July 2023. During target volume delineation, precautions were taken to avoid the reconstructed tissues, which were delineated separately. Customized HT, VMAT, and F_IMRT treatment plans were designed for each patient. The plans were categorized into the HT, VMAT, and F_IMRT groups based on different radiotherapy techniques employed. They were comparatively analyzed through one-way analysis of variance (ANOVA), with multiple comparisons further conducted in the case of significant differences.Results:Statistical analyses reveal significant differences in various parameters of target volumes among the three groups of plans ( F = 38.73, 14.95, 37.01, 48.05, 35.55, 22.56, 34.30, P < 0.05). Pairwise comparisons indicate that the maximum dose ( D2%), minimum dose ( D98%), mean dose ( Dmean), and the proportion of high-dose volumes within the target volume ( V107%and V110%) in both the HT and VMAT groups were significantly better than those in the F_IMRT group. The HT group demonstrated the optimal conformity index (CI), while the VMAT group displayed the superior homogeneity index (HI) compared to the other two groups. In terms of OAR, the V20 of the ipsilateral lung was the lowest in the HT group ( F = 14.31, P < 0.05) and the highest in the F_IMRT group ( F = 14.31, P < 0.05). However, the V5 and Dmean for both the ipsilateral and contralateral lungs in the HT group significantly surpassed those of the other groups ( F = 39.16, 31.91, P < 0.05). The mean dose Dmean ( F = 5.57, P < 0.05) of the contralateral breast was significantly reduced in the VMAT group compared to the other two groups. No statistically significant differences were observed for other OARs, including the heart, spinal cord PRV, thyroid, and humeral head ( P > 0.05). The radiation doses to reconstructed tissues ( Dmax, V53.5, Dmean) ascended in the order of HT, VMAT, and F_IMRT groups ( F = 17.69, 17.53, 15.11, P < 0.05). The HT and F_IMRT groups showed similar beam-on times ( P > 0.05), both exceeding that of the VMAT group by several folds ( F = 28.72, P < 0.05). Conclusions:The comparative analysis indicates that the three radiotherapy techniques exhibit distinct advantages and limitations, with F_IMRT demonstrating the least comprehensive advantage. HT can enhance the conformity of target volumes while reducing the overall radiation doses to reconstructed tissues and the crucial indicator V20 in the ipsilateral lung. VMAT demonstrates the highest treatment efficiency, yielding improved dose uniformity in the target volume and reduced radiation doses to the contralateral breast. It is advisable to prioritize HT or VMAT based on actual clinical conditions.

Osteoporosis is a systemic disease characterized by imbalanced bone metabolism and destruction of bone microstructure, with reduced bone density, decreased bone quality, and significantly increased risk of fracture as its hallmarks. At present, osteoporosis is primarily diagnosed through bone density measurement. However, this method has low sensitivity and is challenging for the early diagnosis of osteoporosis. We analyzed osteoporosis-related metabolomics studies based on blood, urine, and fecal samples, as well as the application of multi-omics approaches in elucidating its pathogenesis. Evidence suggests that metabolomics can detect metabolic alterations prior to measurable changes in bone mineral density, offering promising avenues for early osteoporosis detection. Blood-based metabolomics studies indicate that amino acid metabolism dysregulation is a key feature of osteoporosis. Specifically, glycine, glutamine, lysine, and hydroxyproline exhibit negative correlations with bone mineral density, whereas tryptophan, branched-chain amino acids, and arginine show positive associations. Lipid metabolism disturbances are characterized by increased levels of phosphatidylcholine, phosphatidylethanolamine, and triglycerides, alongside decreased levels of sphingomyelin and carnitine. Fecal metabolomics studies highlight the significance of the "gut-bone axis" in osteoporosis, where gut microbiota dysbiosis influences bone metabolism through modulation of arginine and proline metabolism and aminoacyl-tRNA biosynthesis pathways. Multi-omics approaches integrate metabolomics, genomics, proteomics, and other omics data to provide a more comprehensive understanding of osteoporosis' molecular mechanisms, enabling the identification of key biomarkers and therapeutic targets. Metabolomics holds considerable potential for early diagnosis, while multi-omics integration offers novel insights into the complex pathophysiological mechanisms underlying osteoporosis. As detection technologies and analytical methods continue to advance, omics-based strategies are expected to play a pivotal role in the development of precision medicine for osteoporosis.

Objective To investigate the status of hearing impaired children's hearing device independence skills,and to explore the ways to improve their self-use of hearing equipment.Methods This study surveyed 64 re-habilitation teachers and 411 parents of children with hearing impairment aged 0-12 years.Through face-to-face or remote telephone interview,3 good habits(A asking parents for advice before removing the HA,B putting the de-vice into a moisture-proof box after removing it,C bringing batteries to school and knowing where are them)and 3 key abilities[D wearing the device independently,E replacing the battery independently,and F independently handle foreign bodies in the ear mold(Fa)and water vapor(Fb)]was investigated.The age when mastering skills or de-veloping habits difference of hearing impaired children in different groups were compared.Results ① The ratio of ability D in the bilateral CI group and the bilateral HA group of preschool children was 30.97％and 18.57％respec-tively.Among elementary school children,85.29％and 90.70％had this ability respectively.② The ratio of ability E in the bilateral CI group,the bilateral HA group and the bimodel group were 11.50％,15.71％and 16.49％,re-spectively.Among elementary school children,64.71％,53.49％and 68.52％had this ability,respectively.③Among preschool children,there was no statistical difference in age when different equipment groups developed the three good habits and acquired ability D and E(P＞0.05).④ Among primary school children,there was a statisti-cal difference in the age when different equipment groups formed habit A(P＜0.05),and the age when double CI group had this ability was slightly earlier than the double HA group.There was no significant difference in other abilities among age groups(P＞0.05).Conclusion The age at which hearing impaired children develop the three good habits precedes the age at which they master the key skills,which accords with the law of skill acquisition and development of ordinary children.Corresponding teaching process should be based on the age and ability of hearing-impaired children without considering the type of equipment.

AIM: To investigate how angles kappa and alpha affect postoperative visual quality in patients with multifocal intraocular lens(mIOLs)implantation.METHODS: Retrospective cases series. A total of 46 patients(46 eyes)who underwent phacoemulsification were subsumed. The correlation between Preoperative angles kappa and alpha, wave-front aberrations and objective visual quality of cornea, internal, and total eye after surgery were analyzed using iTrace.RESULTS: The magnitude of angle kappa was negatively correlated with internal and total modulation transfer function(MTF)at 3 mm; the magnitude of angle kappa was positively correlated with astigmatism, trefoil, higher-order aberrations(HOAs)of both internal and total eye at 3 mm. The magnitude of angle alpha was negatively correlated with total MTF and total Strehl ratio at 3 mm. The magnitude of angle alpha was positively correlated with corneal coma at 5 mm, internal astigmatism at both 3 mm and 5 mm, and total spherical aberration(SA)at 3 mm. Multivariate linear regression analysis showed that, among candidate independent variables(kappa, alpha, astigmatism, SA, coma, trefoil, and HOAs), astigmatism is the only independent factor for altering corneal MTF at 3 mm and 5 mm; astigmatism and HOAs emerged as independent factors for altering internal MTF at 3 mm and 5 mm, and total MTF at 3 mm; astigmatism, SA and HOAs emerged as independent factors for altering total MTF at 5 mm.CONCLUSION: With greater preoperative angle kappa or angle alpha, patients who accept mIOL implantation tend to have larger internal astigmatism and HOAs, which resulting in poor visual quality, especially those with small pupil size.

Objective To investigate the status of hearing impaired children's hearing device independence skills,and to explore the ways to improve their self-use of hearing equipment.Methods This study surveyed 64 re-habilitation teachers and 411 parents of children with hearing impairment aged 0-12 years.Through face-to-face or remote telephone interview,3 good habits(A asking parents for advice before removing the HA,B putting the de-vice into a moisture-proof box after removing it,C bringing batteries to school and knowing where are them)and 3 key abilities[D wearing the device independently,E replacing the battery independently,and F independently handle foreign bodies in the ear mold(Fa)and water vapor(Fb)]was investigated.The age when mastering skills or de-veloping habits difference of hearing impaired children in different groups were compared.Results ① The ratio of ability D in the bilateral CI group and the bilateral HA group of preschool children was 30.97％and 18.57％respec-tively.Among elementary school children,85.29％and 90.70％had this ability respectively.② The ratio of ability E in the bilateral CI group,the bilateral HA group and the bimodel group were 11.50％,15.71％and 16.49％,re-spectively.Among elementary school children,64.71％,53.49％and 68.52％had this ability,respectively.③Among preschool children,there was no statistical difference in age when different equipment groups developed the three good habits and acquired ability D and E(P＞0.05).④ Among primary school children,there was a statisti-cal difference in the age when different equipment groups formed habit A(P＜0.05),and the age when double CI group had this ability was slightly earlier than the double HA group.There was no significant difference in other abilities among age groups(P＞0.05).Conclusion The age at which hearing impaired children develop the three good habits precedes the age at which they master the key skills,which accords with the law of skill acquisition and development of ordinary children.Corresponding teaching process should be based on the age and ability of hearing-impaired children without considering the type of equipment.