Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

This study aimed to comprehensively examine the association of gallstones, cholecystectomy, and cancer risk. Multivariable logistic regressions were performed to estimate the observational associations of gallstones and cholecystectomy with cancer risk, using data from a nationwide cohort involving 239 799 participants. General and gender-specific two-sample Mendelian randomization (MR) analysis was further conducted to assess the causalities of the observed associations. Observationally, a history of gallstones without cholecystectomy was associated with a high risk of stomach cancer (adjusted odds ratio (aOR)=2.54, 95% confidence interval (CI) 1.50-4.28), liver and bile duct cancer (aOR=2.46, 95% CI 1.17-5.16), kidney cancer (aOR=2.04, 95% CI 1.05-3.94), and bladder cancer (aOR=2.23, 95% CI 1.01-5.13) in the general population, as well as cervical cancer (aOR=1.69, 95% CI 1.12-2.56) in women. Moreover, cholecystectomy was associated with high odds of stomach cancer (aOR=2.41, 95% CI 1.29-4.49), colorectal cancer (aOR=1.83, 95% CI 1.18-2.85), and cancer of liver and bile duct (aOR=2.58, 95% CI 1.11-6.02). MR analysis only supported the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer. This study added evidence to the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer, highlighting the importance of cancer screening in individuals with gallstones.
Humans ; Mendelian Randomization Analysis ; Gallstones/complications* ; Female ; Male ; Cholecystectomy/statistics & numerical data* ; Middle Aged ; Risk Factors ; Aged ; Adult ; Neoplasms/etiology* ; Stomach Neoplasms/epidemiology*

Objective To introduce the method and results of modeling validation of the treatment planning system used in the first Mevion proton therapy system in China.Methods The SOBP(Spread-Out Bragg Peak)beams in water were designed according to the TG-185 report.The treatment plans in water were designed according to the TG-350 report.The treatment plans of patients were designed on the CT images.The plane dose of each beam was measured by using the MatriXX ONE ioni-zation chambers at different depths in the water,and the measurment results were compared with the TPS calculated results to verify the accuracy of the output doses,the error requirements were 2％/2 mm.Results Except for the distal fall-off position,the doses deviation at the SOBP beams center were less than 3％,and the γ analysis pass rates of plane doses were more than 90％.The measured results of the treatment plan beams were within the tolerance of deviation,and the output doses of the beams without or with static adaptive aperture were more accurate in general.With the decrease of beam energy,the error of dose calculation will increase.Conclusion According to the accuracy requirements of the planning system calculation and treat-ment system implementation,the proton therapy system supporting the treatment planning system has been modeled.Some basic performance such as IDD and beam spot is consistent with the actual measurement,and the TPS modeling conforms to the actual performance of the machine executing when calculating the same proton radiotherapy plan.

Objective To introduce the method and results of modeling validation of the treatment planning system used in the first Mevion proton therapy system in China.Methods The SOBP(Spread-Out Bragg Peak)beams in water were designed according to the TG-185 report.The treatment plans in water were designed according to the TG-350 report.The treatment plans of patients were designed on the CT images.The plane dose of each beam was measured by using the MatriXX ONE ioni-zation chambers at different depths in the water,and the measurment results were compared with the TPS calculated results to verify the accuracy of the output doses,the error requirements were 2％/2 mm.Results Except for the distal fall-off position,the doses deviation at the SOBP beams center were less than 3％,and the γ analysis pass rates of plane doses were more than 90％.The measured results of the treatment plan beams were within the tolerance of deviation,and the output doses of the beams without or with static adaptive aperture were more accurate in general.With the decrease of beam energy,the error of dose calculation will increase.Conclusion According to the accuracy requirements of the planning system calculation and treat-ment system implementation,the proton therapy system supporting the treatment planning system has been modeled.Some basic performance such as IDD and beam spot is consistent with the actual measurement,and the TPS modeling conforms to the actual performance of the machine executing when calculating the same proton radiotherapy plan.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To present and discuss beam characteristics of the first Mevion S250i gantry-mounted accelerator pencil beam scanning proton therapy system in China.Methods The output dose was measured using a parallel-plate ionization chamber.The integrated depth dose was measured with a large-radius Bragg peak ionization chamber,covering 19 energy levels ranging from 227 MeV to 28 MeV,to analyze the proton beam characteristics.The spots in the air were measured with Phoenix flat panel detector on the beam central axis,and the precision of the delivery position was verified by measuring the multi-spot beam map.The interleaf leakage and penumbra reduction of adaptive aperture were measured to characterize its performance.Results The proton system was calibrated for a maximum energy of 227 MeV,with a(10×10)cm2uniform field delivering 1 Gy dose at a depth of 5 cm underwater.The system effectively modulated the proton beam range to the patient's surface,maintaining a constant 80%-80%Bragg peak width of 8.6 mm at all energy levels.The spot size of the highest energy beam at the isocenter was about 4 mm in the air,and the spot delivery position error was less than 1 mm.The interleaf leakage rate of the adaptive aperture for the highest energy beam was below 1.5%,and the penumbra was significantly reduced.Conclusion Mevion S250i proton therapy system demonstrates unique design and beam characteristics,which is reflected in the Bragg peak shape,spot size variation with energy,and penumbra sharpening of adaptive aperture;and these differences should be considered in treatment planning system modeling and planning for precision treatment.

Surgery is still the first choice for patients with hepatocellular carcinoma(HCC).However,about 70%of HCC patients in China are first diagnosed in the advanced stage and have lost the opportunity for surgery.Recently,the rapid development of systematic therapy has brought new hope for patients with advanced HCC.The combination of molecular targeted therapy and immunotherapy with or without local therapy significantly improves the survival of advanced HCC and alters the landscape of surgical treatment in advanced HCC.In addition,systemic therapy also brings new opportunities for perioperative treatment of HCC patients.Conversion therapy,neoadjuvant therapy,and postoperative adjuvant therapy can increase the chances of surgical treatment,reduce the risk of postoperative metastasis and recurrence,and prolong the overall survival of HCC patients.Systematic therapy based on molecular targeted therapy and immunotherapy has been applied through the whole process of HCC surgical treatment,and has completely altered the surgery paradigm of HCC.However,further research is needed to determine the optimal combination protocol,screen the sensitive populations,address drug resistance,and reduce systemic adverse events.

Objective To evaluate the dose distribution of hippocampal sparing whole-brain proton therapy based on the treatment planning system of Mevion S250i proton therapy system.Methods Twenty patients undergoing hippocampal sparing whole-brain radiotherapy were selected.Under the same optimal conditions,plans using VMAT,fixed-angle IMPT without a-daptive aperture,IMPT with static adaptive aperture and IMPT with dynamic adaptive aperture were designed for each pa-tient.HI,CI,GI and the dose of hippocampus,lens,optic nerve,cochlea in different groups were compared.Results Compared with the VMAT plans,the IMPT plans without the adaptive aperture improved the target homogeneity index from(0.45±0.15)to(0.60±0.08),and the high-dose D2 in the targets decreased from(3368.22±65.94)cGy to(3270.67±104.78)cGy,and the irradiation doses of the hippocampus,lens and cochlea were significantly reduced(P＜0.05).The target gradient of IM-PT plans could be improved using static adaptive aperture,and the dose of lens could be further reduced(P＜0.05).The target gradient and conformal degree of the IMPT plans were significantly improved using dynamic adaptive aperture,and the dose of the optic nerves,lens and cochleae were further reduced(P＜0.05).Conclusion IMPT has a dosimetric advantage over VMAT in hippocampal sparing whole-brain radiotherapy.The use of Mevion adaptive aperture can not only further optimize the dose to the target area,but also minimize the radiation doses to the normal tissue around the target area,which has a good clinical appli-cation prospect.

Objective:To evaluate the clinical application value of the adaptive aperture by comparing intensity-modulated proton radiotherapy(IMPT) plans using and not using the aperture for brain tumors.Methods:A total of twenty patients treated with postoperative radiotherapy for brain tumors were enrolled in this study. IMPT plans were developed for each patient using and not using the adaptive aperture under the same optimization conditions. The target conformal index (CI) value, target homogeneity index (HI) value, and the dose to normal tissues of the two sets of plans were compared.Results:The IMPT plans designed using the adaptive aperture significantly increased the mean CI value from 0.58 to 0.66, while decreasing the mean 50% prescription dose volume from 797.70 cm 3 to 638.15 cm 3. These plans also reduced the irradiation doses to the cochlea, brainstem, optic chiasm, optic nerve, and lens ( t = 2.06, 3.02, 2.11, 2.58, 2.67, P < 0.05). Additionally, there was no significant difference in the HI value of the target volumes and the machine jumps (MU) between the two sets of plans ( P > 0.05). Conclusions:The adaptive aperture can significantly reduce the irradiation dose to normal tissues outside the target volumes, positively impacting the protection of organs at risk (OARs) around the target values. This demonstrates its great potential for clinical application.

Objective To analyze the daily quality assurance(QA)measurement results of IBA Sphinx Compact device on the Mevion compact pencil beam scanning proton therapy system for evaluating its clinical application value in proton therapy.Methods The daily QA measurement of Mevion S250i proton therapy system was carried out with Sphinx Compact device for 30 consecutive days,and the measurement results were analyzed.Results The average deviation between the positioning laser and the image center was(0.42±0.27)mm in 30 days.All of the proximal and distal depth errors of the high-and low-energy pencil beams were within 0.50 mm.The position deviation of all the spots measured did not exceed 1.00 mm,and the size deviation was less than 7.5%.The deviation between the image center and the beam center was not more than 0.75 mm.The relative deviation of the flatness of the rectangular field was about 0.5%.The deviation of the output dose of the square field was within 1.0%.Conclusion The proton system daily QA measurement items recommended by AAPM TG-224 report can be accurately and rapidly measured with Sphinx Compact device.The device is a practical and efficient daily QA tool with high practical value in clinic.