Definitive treatment of lung cancer with radiotherapy is challenging, as respiratory motion and anatomical changes can increase the risk of severe off-target effects during radiotherapy. Online adaptive radiotherapy (ART) is an evolving approach that enables timely modification of a treatment plan during the interfraction of radiotherapy, in response to physiologic or anatomic variations, aiming to improve the dose distribution for precise targeting and delivery in lung cancer patients. The effectiveness of online ART depends on the seamless integration of multiple components: sufficient quality of linear accelerator-integrated imaging guidance, deformable image registration, automatic recontouring, and efficient quality assurance and workflow. This review summarizes the present status of online ART for lung cancer, including key technologies, as well as the challenges and areas of active research in this field.
Humans ; Lung Neoplasms/radiotherapy* ; Radiotherapy Planning, Computer-Assisted/methods*

OBJECTIVE To evaluate the quality of diagnosis and treatment guidelines and expert consensuses on childhood immune thrombocytopenic purpura(ITP)published domestically and internationally,in order to provide reference for clinical practice and future guideline/expert consensus development and improvement.METHODS A systematic search was conducted across multiple databases,including PubMed,Cochrane Library,Embase,CNKI,Wanfang data,VIP,CBM;additionally,supplementary searches were carried out on websites such as Medlive,the Chinese Medical Association's official website,and National Institute for Health and Clinical Excellence in the UK.The retrieval time ranged from the inception to September 2,2024.Researchers who had undergone systematic training independently evaluated the methodology and report quality included in the guideline/consensus using the Appraisal of Guidelines Research and Evaluation Ⅱ(AGREE Ⅱ)and the Reporting Items for Practice Guidelines in Healthcare(RIGHT).RESULTS A total of 11 guidelines/consensuses were included.The average scores for the six domains of AGREE Ⅱ tool respectively were"range and purpose"[(66.67±17.98)%],"participants"[58.33%(13.89%,73.61%)],"rigor"[(41.81±23.85)%],"clarity"[(69.57±19.35)%],"applicability"[(35.98±17.83)%],and"independence"[27.08%(0,75.00%)];out of 11 articles,9 had a recommendation level of B,2 had a recommendation level of C,and there were no A-level articles.The average reporting rates of the 7 areas in the RIGHT tool were"basic information"[(72.35±12.95)%],"background"[(54.55±15.40)%],"evidence"[(36.36±24.81)%],"recommended opinions"[(53.25±19.20)%],"review and quality assurance"[0(0,25.00%)],"funding and conflict of interest statement and management"[12.50%(0,25.00%)],and other aspects[8.33%(0,50.00%)].In addition,there was no statistically significant difference in the AGREE Ⅱ and RIGHT scores between the guidelines and consensuses(P＞0.05).CONCLUSIONS The overall quality of the guidelines and consensuses included in this study is not high,with a recommended level of B or C.It is recommended that clinical decision-making prioritize referring to the relatively high-quality guideline/consensus among them.The quality of evidence in the existing traditional Chinese medicine guidelines for children with ITP needs to be improved,and there is no integrated guideline/consensus for traditional Chinese and Western medicine.It is recommended to revise or write relevant guideline/consensus according to the requirements of AGREE Ⅱ and RIGHT in various fields to guide clinical practice.

Objective To investigate the distribution and antimicrobial resistance profiles of pathogenic bacteria in Children's Hospital of Hebei Province to inform reasonable use of antibiotics.Methods Antimicrobial susceptibility of the bacterial isolates was tested using Kirby-Bauer method,VITEK-2 Compact,BD Phoenix 100 automated systems,and E-test method.The results were interpreted according to the breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) in 2022.Results were analyzed by WHONET 5.6 software.Results A total of 11909 isolates were collected from 2020 to 2022,of which 45.1％ were Gram positive organisms and 54.9％ were Gram negative organisms.The prevalence of MRSA and in S.aureus and MRCNS in coagulase-negative Staphylococcus was 36.8％ and 73.8％,respectively.The resistance rate of Enterococcus faecalis and Enterococcus faecium to ampicillin was 2.6％ and 93.5％,respectively,while the resistance rates of E.faecalis and E.faecium to high concentration gentamicin was 42.2％ and 66.2％,respectively.E.faecium showed significantly higher resistance rates to the antibiotics tested than E.faecalis.The prevalence of PRSP and PSSP was 1.7％ and 95.7％ respectively in the non-meningitis S.pneumoniae isolates.No vancomycin-or linezolid-resistant strains were found in Staphylococcus,Enterococcus,or Streptococcus.The prevalence of ESBLs-producing E.coli and K.pneumoniae was 47.4％ and 32.3％,respectively.The prevalence of carbapenem-resistant E.coli and K.pneumoniae was 2.0％ and 22.4％,respectively.The prevalence of carbapenem-resistant P.aeruginosa (CRPA) and carbapenem-resistant A.baumannii (CRAB) was 9.5％ and 22.1％,respectively.The resistance rate of Haemophilus influenzae to ampicillin was 83.8％.The prevalence of β-lactamase-producing H.influenzae and β-lactamase-non-producing ampicillin-resistant (BLNAR) H.influenzae was 76.1％ and 7.7％,respectively.No meropenem-resistant strains were found in H.influenzae.Majority (98.0％) of Moraxella catarrhalis strains produced β-lactamase.Conclusions Multi-drug resistant bacterial pathogens are still serious in pediatric inpatients.The common clinical isolates showed various levels of resistance to different antimicrobial agents.It is important to continue the surveillance of bacterial resistance in children,take proactive measures to curb the spread of drug-resistant bacteria,and use antibiotics rationally.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To investigate the distribution and antimicrobial resistance profiles of pathogenic bacteria in Children's Hospital of Hebei Province to inform reasonable use of antibiotics.Methods Antimicrobial susceptibility of the bacterial isolates was tested using Kirby-Bauer method,VITEK-2 Compact,BD Phoenix 100 automated systems,and E-test method.The results were interpreted according to the breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) in 2022.Results were analyzed by WHONET 5.6 software.Results A total of 11909 isolates were collected from 2020 to 2022,of which 45.1％ were Gram positive organisms and 54.9％ were Gram negative organisms.The prevalence of MRSA and in S.aureus and MRCNS in coagulase-negative Staphylococcus was 36.8％ and 73.8％,respectively.The resistance rate of Enterococcus faecalis and Enterococcus faecium to ampicillin was 2.6％ and 93.5％,respectively,while the resistance rates of E.faecalis and E.faecium to high concentration gentamicin was 42.2％ and 66.2％,respectively.E.faecium showed significantly higher resistance rates to the antibiotics tested than E.faecalis.The prevalence of PRSP and PSSP was 1.7％ and 95.7％ respectively in the non-meningitis S.pneumoniae isolates.No vancomycin-or linezolid-resistant strains were found in Staphylococcus,Enterococcus,or Streptococcus.The prevalence of ESBLs-producing E.coli and K.pneumoniae was 47.4％ and 32.3％,respectively.The prevalence of carbapenem-resistant E.coli and K.pneumoniae was 2.0％ and 22.4％,respectively.The prevalence of carbapenem-resistant P.aeruginosa (CRPA) and carbapenem-resistant A.baumannii (CRAB) was 9.5％ and 22.1％,respectively.The resistance rate of Haemophilus influenzae to ampicillin was 83.8％.The prevalence of β-lactamase-producing H.influenzae and β-lactamase-non-producing ampicillin-resistant (BLNAR) H.influenzae was 76.1％ and 7.7％,respectively.No meropenem-resistant strains were found in H.influenzae.Majority (98.0％) of Moraxella catarrhalis strains produced β-lactamase.Conclusions Multi-drug resistant bacterial pathogens are still serious in pediatric inpatients.The common clinical isolates showed various levels of resistance to different antimicrobial agents.It is important to continue the surveillance of bacterial resistance in children,take proactive measures to curb the spread of drug-resistant bacteria,and use antibiotics rationally.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

【Objective】 To perform serological screening of K antigen in Qingdao area and analyze the results. 【Methods】 From March to June 2023, 16 201 samples of patients treated in our hospital and applied for blood grouping, and 4 153 samples of blood donors sent to the clinic by Blood Transfusion Department during the same period were detected for Rh and K antigen by Ortho BioVue System Rh/K Cassette. 【Results】 A total of 18 out of 16 201 patient samples and 8 out of 4 153 blood donor samples were positive for K antigen, with the positive rate at 0.127 7%. 【Conclusion】 There was K antigen in Qingdao population, and the positive frequency of K antigen was different from previous reports. It is of great significance to construct rare blood group bank in this area and formulate reasonable blood donation and transfusion strategy for population with K antigen, so as to avoid unexpected antibody production of Kell blood group system, prevent hemolytic disease of newborn and ensure the safety of blood use.

Objective:To investigate the expression level, development mechanism, role and clinical prognostic significance of tweety homolog 2 (TTYH2) in cutaneous melanoma (SKCM).Methods:The expression data and clinical information of 365 cutaneous melanoma patients were downloaded from the Cancer Genome Atlas (TCGA), and the expression data of 812 normal tissues were retrieved from the genotype and Genotype-Tissue Expression(GTEx) to analyze the expression level of TTYH2 in SKCM tissues and normal counterparts. Survival analysis and Cox proportional hazard regression analysis were used to evaluate the effect of TTYH2 expression on prognosis and survival in SKCM patients. Gene set enrichment analysis Kyoto Genome Encyclopedia (KEGG) and Gene Ontology (GO) were used to screen signaling pathways for significant TTYH2 enrichment. The interaction network analysis was carried out using STRING online platform to screen key protein network node genes. Secondly, CIBERSORT algorithm was used to analyze the expression of 22 immune cells in each sample, and Chi-square test was applied to analyze the difference of immune cells in the high-low expression group.Results:The expression of TTYH2 in SKCM patients was significantly higher than that in normal tissues. Survival analysis showed that SKCM patients with high TTYH2 expression group had a poor prognosis. High TTYH2 expression was an independent predictor of poor overall survival of SKCM ( HR=1.21, 95% CI 1.08-1.37, P=0.001). KEGG result showed that TTYH2 was mainly concentrated in cell synapses, ion channels, calcium signaling pathways and extracellular matrix receptor interaction pathways. GO analysis showed that the biological processes involved in TTYH2 may be closely related to the occurrence and development of tumors. TTYH2 interacts with chloride intracellular channel protein 5, chloride ion channel protein 2, glycine receptor family members and gamma-aminobutyric acid receptor family members, suggesting that TTYH2 may play an important role in the pathogenesis of SKCM. Immune cell infiltration analysis showed that the immune cell abundance of memory B cells, CD4 memory T cells and monocytes was significantly increased in the TTYH2 low expression group, while the immune abundance of follicular helper T cells and regulatory T cells was significantly decreased in the TTYH2 low expression group. Conclusion:TTYH2 expression may regulate the development of SKCM cells through various ways, affect the survival and prognosis of SKCM patients, and is a potential biological prognostic marker and therapeutic target of SKCM.

Objective:To investigate the expression level, development mechanism, role and clinical prognostic significance of tweety homolog 2 (TTYH2) in cutaneous melanoma (SKCM).Methods:The expression data and clinical information of 365 cutaneous melanoma patients were downloaded from the Cancer Genome Atlas (TCGA), and the expression data of 812 normal tissues were retrieved from the genotype and Genotype-Tissue Expression(GTEx) to analyze the expression level of TTYH2 in SKCM tissues and normal counterparts. Survival analysis and Cox proportional hazard regression analysis were used to evaluate the effect of TTYH2 expression on prognosis and survival in SKCM patients. Gene set enrichment analysis Kyoto Genome Encyclopedia (KEGG) and Gene Ontology (GO) were used to screen signaling pathways for significant TTYH2 enrichment. The interaction network analysis was carried out using STRING online platform to screen key protein network node genes. Secondly, CIBERSORT algorithm was used to analyze the expression of 22 immune cells in each sample, and Chi-square test was applied to analyze the difference of immune cells in the high-low expression group.Results:The expression of TTYH2 in SKCM patients was significantly higher than that in normal tissues. Survival analysis showed that SKCM patients with high TTYH2 expression group had a poor prognosis. High TTYH2 expression was an independent predictor of poor overall survival of SKCM ( HR=1.21, 95% CI 1.08-1.37, P=0.001). KEGG result showed that TTYH2 was mainly concentrated in cell synapses, ion channels, calcium signaling pathways and extracellular matrix receptor interaction pathways. GO analysis showed that the biological processes involved in TTYH2 may be closely related to the occurrence and development of tumors. TTYH2 interacts with chloride intracellular channel protein 5, chloride ion channel protein 2, glycine receptor family members and gamma-aminobutyric acid receptor family members, suggesting that TTYH2 may play an important role in the pathogenesis of SKCM. Immune cell infiltration analysis showed that the immune cell abundance of memory B cells, CD4 memory T cells and monocytes was significantly increased in the TTYH2 low expression group, while the immune abundance of follicular helper T cells and regulatory T cells was significantly decreased in the TTYH2 low expression group. Conclusion:TTYH2 expression may regulate the development of SKCM cells through various ways, affect the survival and prognosis of SKCM patients, and is a potential biological prognostic marker and therapeutic target of SKCM.