Objective:To investigate the impact of different target sites, number of treatments, and age on setup errors in dual-isocenter radiotherapy for breast cancer, and to provide a basis for planning target volume (PTV) margin expansion.Methods:A retrospective analysis was conducted on data from 15 patients with left-sided breast cancer who underwent dual-isocenter breath-hold radiotherapy in the Department of Radiotherapy Oncology at the Second Hospital of Hebei Medical University from May 2021 to May 2023. Setup errors were acquired using a Varian TrueBeam STX linear accelerator. Patients were grouped by target site (supraclavicular/chest wall), treatment phase (early/late), and age (younger/older). Non-parametric tests were used to analyze differences in setup errors in : vertical (Vrt), longitudinal (Lng), lateral (Lat) directions, and pitch, roll, and rotation (Rtn) angles. The formula proposed by van Herk was applied to calculate PTV margins.Results:The Vrt direction setup error in the supraclavicular region (0.2 cm) was smaller than that in the chest wall region (0.26 cm), but errors and margin expansions in other directions were larger ( P<0.05 for Lng and Lat directions). No significant correlation was observed in Vrt direction errors between the two sites ( P=0.062), while significant correlations were found in the other directions and angles (all P<0.05). As treatment progressed, setup errors increased in the Vrt and Rtn directions for the supraclavicular region, and in the Vrt, Lng, Lat directions and Rtn angle for the chest wall region. Among these, only the increase in Lat direction error for the chest wall region was statistically significant ( P=0.028). The PTV margins in the late phase group (except for the Lat direction of the supraclavicular region) were greater than or equal to those in the early phase group. Elderly patients had significantly larger setup errors than younger patients in Vrt, Lng, and Lat directions for the supraclavicular region, as well as in Vrt and Lat directions for the chest wall region (all P<0.05). Conclusions:In dual-isocenter radiotherapy for breast cancer, the supraclavicular region requires larger PTV margins than the chest wall region, and elderly patients require greater margins overall. Mid-course rescanning is recommended. If cone-beam CT guidance cannot be ensured for every session, expansion of PTV margins should be considered for the supraclavicular region and elderly patients to reduce the risk of geographic miss.

OBJECTIVE: To develop a method for identifying high-risk patients among septic populations requiring mechanical ventilation, and to conduct phenotypic analysis based on this method. METHODS: Data from four sources were utilized: the Medical Information Mart for Intensive Care (MIMIC-IV 2.0, MIMIC-III 1.4), the Philips eICU-Collaborative Research Database 2.0 (eICU-CRD 2.0), and the Anhui Medical University Second Affiliated Hospital dataset. The adult patients in intensive care unit (ICU) who met Sepsis-3 and received invasive mechanical ventilation (IMV) on the first day of first admission were enrolled. The MIMIC-IV dataset with the highest data integrity was divided into a training set and a test set at a 6:1 ratio, while the remaining datasets were served as validation sets. The demographic information, comorbidities, laboratory indicators, commonly used ICU scores, and treatment measures of patients were extracted. Clinical data collected within first day of ICU admission were used to calculate the sequential organ failure assessment (SOFA) score. K-means clustering was applied to cluster SOFA score components, and the sum of squared errors (SSE) and Davies-Bouldin index (DBI) were used to determine the optimal number of disease subtypes. For clustering results, normalized methods were employed to compare baseline characteristics by visualization, and Kaplan-Meier curves were used to analyze clinical outcomes across phenotypes. RESULTS: This study enrolled patients from MIMIC-IV dataset (n = 11 166), MIMIC-III dataset (n = 4 821), eICU-CRD dataset (n = 6 624), and a local dataset (n = 110), with the four datasets showing similar median ages and male proportions exceeding 50%; using 85% of the MIMIC-IV dataset as the training set, 15% as the test set, and the rest dataset as the validation set. K-means clustering based on the six-item SOFA score was performed to determine the optimal number of clusters as 3, and patients were finally classified into three phenotypes. In the training set, compared with the patients with phenotype II and phenotype III, those with phenotype I had the more severe circulatory and respiratory dysfunction, a higher proportion of vasoactive drug usage, more obvious metabolic acidosis and hypoxia, and a higher incidence of congestive heart failure. The patients with phenotype II was dominated by respiratory dysfunction with higher visceral injury. The patients with phenotype III had relatively stable organ function. The above characteristics were consistent in both the test and validation sets. Analysis of infection-related indicators showed that the patients with phenotype I had the highest SOFA score within 7 days after ICU admission, initial decreases and later increases in platelet count (PLT), and higher counts of neutrophils, lymphocytes, and monocytes as compared with those with phenotype II and phenotype III, their blood cultures had a higher positivity rates for Gram-positive bacteria, Gram-negative bacteria and fungi as compared with those with phenotype II and phenotype III. The Kaplan-Meier curve indicated that in the training, test, and validation sets, the 28-day cumulative mortality of patients with phenotype I was significantly higher than that of patients with phenotypes II and phenotype III. CONCLUSIONS Three distinct phenotypes in septic patients receiving IMV based on unsupervised machine learning is derived, among which phenotype I, characterized by cardiorespiratory failure, can be used for the early identification of high-risk patients in this population. Moreover, this population is more prone to bloodstream infections, posing a high risk and having a poor prognosis.
Humans ; Machine Learning ; Sepsis/therapy* ; Respiration, Artificial ; Intensive Care Units ; Organ Dysfunction Scores ; Male ; Female ; Middle Aged ; Adult

Objective:To analyze the temporal trends and projections in disease burden attributable to preterm birth and low birth weight (PBLBW) in China from 1990 to 2021, providing evidence for prevention strategies.Methods:Using Global Burden of Disease (GBD) 2021 data, deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASR) related to PBLBW were calculated. Joinpoint regression analyzed temporal trends, disease-specific impacts, sex/age disparities, and comparisons with socio-demographic index (SDI) regions. An autoregressive integrated moving average (ARIMA) model projected future trends.Results:In 2021, age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) for PBLBW were 3.89/100 000 and 413.24 years/100 000, respectively, which demonstrated a significant decline from 1990 levels (21.80/100 000 and 2 027.96 years/100 000), with average annual percentage changes (AAPC) of－5.39 and－5.03. Male burden exceeded female in 2021 (ASMR: 4.35/100 000 vs. 3.36/100 000; ASDR: 459.48 years/100 000 vs. 359.55 years/100 000). Preterm birth dominated PBLBW-related mortality and DALYs in 2021 (ASMR: 2.65/100 000; ASDR: 301.50 years/100 000). ASMR and ASDR of China in 2021 were lower than that of low-, low-middle-, and middle-SDI regions and global levels, with greater declines during 1990-2021 than that of global levels and all SDI regions. Projections indicate continued decline to 2030 (ASMR: 1.63/100 000; ASDR: 212.62 years/100 000). Conclusion:China achieved substantial reductions in PBLBW-related disease burden, although persistent gender disparities and methodological limitations in data collection necessitate further strengthening of the perinatal healthcare system.

Objective To investigate the protective effects of Kaempferol(KAE)against hepatic lipid de-position induced by a high-fat diet,as well as the underlying mechanisms.Methods C57BL/6J male mice were fed a high-fat diet for 22 weeks to establish a chronic nonalcoholic steatohepatitis(NASH)model.KAE was admin-istered during the last 8 weeks as an interventional agent to evaluate its effects.Liver lipid deposition was assessed,and the expression levels of endoplasmic reticulum(ER)stress-related proteins,activation of the Farnesoid X Re-ceptor(FXR)signaling pathway,and the expression of lipid synthesis-related genes were analyzed.In vitro,pal-mitic acid(PA)was used to stimulate AML-12 cells to induce lipid accumulation.Additionally,siRNA targeting FXR was transfected into AML-12 cells to investigate the role of the ER stress-FXR signaling pathway in mediating the effects of KAE.Results The intervention of kaempferol inhibited the rapid weight gain induced by a high-fat diet,reduced serum total cholesterol,triglyceride levels,and ALT activity,effectively alleviated large-scale lipid aggregation in the liver,thereby exerting a protective effect against hepatic lipid deposition in NASH.Mechanisti-cally,KAE decreased hepatic ER stress,promoted the expression of FXR and its activation marker SHP,thereby suppressing the expression of FASN and reducing hepatic lipid synthesis.In vitro,KAE treatment significantly re-versed the inhibitory effect of excessive ER stress on FXR activity,as evidenced by the upregulation of FXR activ-ity leading to decreased FASN expression and reduced steatosis in AML-12 cells.Moreover,FXR knockdown mark-edly abolished the protective effects of KAE on lipid deposition in AML-12 cells exposed to PA,by eliminating the promoting effect of KAE on SHP expression and the SHP-mediated suppression of SREBP1c.Conclusions KAE treatment alleviated ER stress,thereby enhancing FXR/SHP signaling and subsequently suppressing lipid synthesis to reduce hepatic lipid accumulation.These findings suggest that KAE holds therapeutic potential for the manage-ment of hepatic steatosis in NASH.

Objective To explore and analyze the characteristics and transmission routes of carbapenem-resistant Klebsiella pneumoniae(CRKP)strains in intensive care unit(ICU).Methods From January to October 2023,17 clinical infection isolates(clinical infection group),5 active screening isolates(active screening group),and 7 envi-ronmental isolates(environmental group)of CRKP in the liver surgery ICU of a hospital were selected and analyzed by whole-genome sequencing.The differences in resistance genes,virulence genes,and sequence typing(ST)were compared,and transmission routes were analyzed based on the phylogenetic tree.Results 29 strains of CRKP car-ried 4-18 resistance genes and 52-98 virulence genes,respectively.There were no statistically significant diffe-rences in genotype distribution of resistance genes,the number of virulence genes,and gene types among three groups of CRKP(all P＞0.05).ST showed that 29 CRKP strains mainly consisted of two categories:ST11 and ST15.Based on the phylogenetic tree constructed from the core genome,there were 7 highly homologous groups of CRKP,among which 4 groups had clear epidemiological associations.Conclusion CRKP in ICU carries more re-sistance and virulence genes,and some strains are highly homologous in ST and phylogenetic tree,which may lead to cross transmission.In the future,prevention and control measures should be strengthened to reduce the trans-mission of CRKP.

Objective:To investigate the sleep status of conscious patients in the ICU, their perception of ICU environmental stressors, and the correlation between the two, providing a basis for nursing interventions.Methods:A convenience sampling method was used to recruit 120 conscious patients admitted to Zhongshan Hospital, Fudan University for the first time to the ICU from August 2022 to January 2023 for the study. Data were collected using a general information questionnaire, the Intensive Care Unit Environmental Stressor Scale (ICUESS), and the Richards-Campbell Sleep Questionnaire (RCSQ). Multiple linear regression analysis was performed to identify factors influencing sleep quality in conscious ICU patients.Results:The total RCSQ and ICUESS scores of 120 conscious ICU patients were 36.0 (12.3, 60.8) and 76.0 (69.0±84.0), respectively. The primary stressors identified by patients were "inability to fall asleep" "thirst" and "restraint by medical tubing". Multiple linear regression analysis showed that the treatment environment, one's own experience and noise were significant factors affecting sleep quality in conscious ICU patients ( P<0.05) . Conclusions:The overall sleep quality of conscious ICU patients was poor and closely related to their perceived level of ICU environmental stressors. ICU medical staff should focus on optimizing the treatment environment, noise and patients' own experience to improve their sleep quality.

Objective To investigate the protective effects of Kaempferol(KAE)against hepatic lipid de-position induced by a high-fat diet,as well as the underlying mechanisms.Methods C57BL/6J male mice were fed a high-fat diet for 22 weeks to establish a chronic nonalcoholic steatohepatitis(NASH)model.KAE was admin-istered during the last 8 weeks as an interventional agent to evaluate its effects.Liver lipid deposition was assessed,and the expression levels of endoplasmic reticulum(ER)stress-related proteins,activation of the Farnesoid X Re-ceptor(FXR)signaling pathway,and the expression of lipid synthesis-related genes were analyzed.In vitro,pal-mitic acid(PA)was used to stimulate AML-12 cells to induce lipid accumulation.Additionally,siRNA targeting FXR was transfected into AML-12 cells to investigate the role of the ER stress-FXR signaling pathway in mediating the effects of KAE.Results The intervention of kaempferol inhibited the rapid weight gain induced by a high-fat diet,reduced serum total cholesterol,triglyceride levels,and ALT activity,effectively alleviated large-scale lipid aggregation in the liver,thereby exerting a protective effect against hepatic lipid deposition in NASH.Mechanisti-cally,KAE decreased hepatic ER stress,promoted the expression of FXR and its activation marker SHP,thereby suppressing the expression of FASN and reducing hepatic lipid synthesis.In vitro,KAE treatment significantly re-versed the inhibitory effect of excessive ER stress on FXR activity,as evidenced by the upregulation of FXR activ-ity leading to decreased FASN expression and reduced steatosis in AML-12 cells.Moreover,FXR knockdown mark-edly abolished the protective effects of KAE on lipid deposition in AML-12 cells exposed to PA,by eliminating the promoting effect of KAE on SHP expression and the SHP-mediated suppression of SREBP1c.Conclusions KAE treatment alleviated ER stress,thereby enhancing FXR/SHP signaling and subsequently suppressing lipid synthesis to reduce hepatic lipid accumulation.These findings suggest that KAE holds therapeutic potential for the manage-ment of hepatic steatosis in NASH.

Objective To explore and analyze the characteristics and transmission routes of carbapenem-resistant Klebsiella pneumoniae(CRKP)strains in intensive care unit(ICU).Methods From January to October 2023,17 clinical infection isolates(clinical infection group),5 active screening isolates(active screening group),and 7 envi-ronmental isolates(environmental group)of CRKP in the liver surgery ICU of a hospital were selected and analyzed by whole-genome sequencing.The differences in resistance genes,virulence genes,and sequence typing(ST)were compared,and transmission routes were analyzed based on the phylogenetic tree.Results 29 strains of CRKP car-ried 4-18 resistance genes and 52-98 virulence genes,respectively.There were no statistically significant diffe-rences in genotype distribution of resistance genes,the number of virulence genes,and gene types among three groups of CRKP(all P＞0.05).ST showed that 29 CRKP strains mainly consisted of two categories:ST11 and ST15.Based on the phylogenetic tree constructed from the core genome,there were 7 highly homologous groups of CRKP,among which 4 groups had clear epidemiological associations.Conclusion CRKP in ICU carries more re-sistance and virulence genes,and some strains are highly homologous in ST and phylogenetic tree,which may lead to cross transmission.In the future,prevention and control measures should be strengthened to reduce the trans-mission of CRKP.

Objective:To investigate the sleep status of conscious patients in the ICU, their perception of ICU environmental stressors, and the correlation between the two, providing a basis for nursing interventions.Methods:A convenience sampling method was used to recruit 120 conscious patients admitted to Zhongshan Hospital, Fudan University for the first time to the ICU from August 2022 to January 2023 for the study. Data were collected using a general information questionnaire, the Intensive Care Unit Environmental Stressor Scale (ICUESS), and the Richards-Campbell Sleep Questionnaire (RCSQ). Multiple linear regression analysis was performed to identify factors influencing sleep quality in conscious ICU patients.Results:The total RCSQ and ICUESS scores of 120 conscious ICU patients were 36.0 (12.3, 60.8) and 76.0 (69.0±84.0), respectively. The primary stressors identified by patients were "inability to fall asleep" "thirst" and "restraint by medical tubing". Multiple linear regression analysis showed that the treatment environment, one's own experience and noise were significant factors affecting sleep quality in conscious ICU patients ( P<0.05) . Conclusions:The overall sleep quality of conscious ICU patients was poor and closely related to their perceived level of ICU environmental stressors. ICU medical staff should focus on optimizing the treatment environment, noise and patients' own experience to improve their sleep quality.

Objective:To analyze the temporal trends and projections in disease burden attributable to preterm birth and low birth weight (PBLBW) in China from 1990 to 2021, providing evidence for prevention strategies.Methods:Using Global Burden of Disease (GBD) 2021 data, deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASR) related to PBLBW were calculated. Joinpoint regression analyzed temporal trends, disease-specific impacts, sex/age disparities, and comparisons with socio-demographic index (SDI) regions. An autoregressive integrated moving average (ARIMA) model projected future trends.Results:In 2021, age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) for PBLBW were 3.89/100 000 and 413.24 years/100 000, respectively, which demonstrated a significant decline from 1990 levels (21.80/100 000 and 2 027.96 years/100 000), with average annual percentage changes (AAPC) of－5.39 and－5.03. Male burden exceeded female in 2021 (ASMR: 4.35/100 000 vs. 3.36/100 000; ASDR: 459.48 years/100 000 vs. 359.55 years/100 000). Preterm birth dominated PBLBW-related mortality and DALYs in 2021 (ASMR: 2.65/100 000; ASDR: 301.50 years/100 000). ASMR and ASDR of China in 2021 were lower than that of low-, low-middle-, and middle-SDI regions and global levels, with greater declines during 1990-2021 than that of global levels and all SDI regions. Projections indicate continued decline to 2030 (ASMR: 1.63/100 000; ASDR: 212.62 years/100 000). Conclusion:China achieved substantial reductions in PBLBW-related disease burden, although persistent gender disparities and methodological limitations in data collection necessitate further strengthening of the perinatal healthcare system.