Objective To compare the radiotherapy treatment accuracy between 4D-CT and DIBH follow-ing liver SBRT,and to illustrate the relevant factors.Methods A retrospective analysis was conducted on the clinical data of 28 liver cancer patients who underwent SBRT from November 2020 to July 2024,all of whom exhib-ited and localizedmorphological changes on magnetic resonance imaging(MRI).Among them,8 patients used DIBH,and 17 patients used 4D-CT.The areas of localized MRI-morphologic alterations(MMA)were delineated on post-therapeutic MRI.Different isodose structures were generated on the planning CT,and after performing de-formation registration based on the liver's region of interest(ROI),the most suitable isodose structure and MMA contours were compared to obtain quantitative accuracy indices.Correlations between factors such as GTV,PTV,liver volume,and volume changes,and the accuracy indices were analyzed.Results The DSC accuracy for the DIBH group was(0.66±0.17),range 0.32～0.90,while the DSC accuracy for the 4D CT group was(0.69±0.10),range 0.49～0.80.T-test analysis showed no significant statistical differences in accuracy indices between the DIBH and 4D CT groups(P<0.05).Correlation analysis revealed that,in both groups,distance-based indices(HD,MDA,3D-CoMD)were more strongly correlated with accuracy indices than conformality indices(DSC,CIMI).Conclusion There was no significant difference in treatment accuracy between the DIBH and 4D-CT groups,although the maximum accuracy in the DIBH group was higher than that in the 4D-CT group.This method can serve as an bench-markingtool for evaluating the accuracy of liver SBRT.It is recommended to prioritize the use of conformality indices,DSC and CIMI,when assessing the treatment accuracy of liver cancer SBRT using this approach.

Objective To compare the radiotherapy treatment accuracy between 4D-CT and DIBH follow-ing liver SBRT,and to illustrate the relevant factors.Methods A retrospective analysis was conducted on the clinical data of 28 liver cancer patients who underwent SBRT from November 2020 to July 2024,all of whom exhib-ited and localizedmorphological changes on magnetic resonance imaging(MRI).Among them,8 patients used DIBH,and 17 patients used 4D-CT.The areas of localized MRI-morphologic alterations(MMA)were delineated on post-therapeutic MRI.Different isodose structures were generated on the planning CT,and after performing de-formation registration based on the liver's region of interest(ROI),the most suitable isodose structure and MMA contours were compared to obtain quantitative accuracy indices.Correlations between factors such as GTV,PTV,liver volume,and volume changes,and the accuracy indices were analyzed.Results The DSC accuracy for the DIBH group was(0.66±0.17),range 0.32～0.90,while the DSC accuracy for the 4D CT group was(0.69±0.10),range 0.49～0.80.T-test analysis showed no significant statistical differences in accuracy indices between the DIBH and 4D CT groups(P<0.05).Correlation analysis revealed that,in both groups,distance-based indices(HD,MDA,3D-CoMD)were more strongly correlated with accuracy indices than conformality indices(DSC,CIMI).Conclusion There was no significant difference in treatment accuracy between the DIBH and 4D-CT groups,although the maximum accuracy in the DIBH group was higher than that in the 4D-CT group.This method can serve as an bench-markingtool for evaluating the accuracy of liver SBRT.It is recommended to prioritize the use of conformality indices,DSC and CIMI,when assessing the treatment accuracy of liver cancer SBRT using this approach.

Objective:To explore the effects of continuous nursing based on timing theory on quality of life, self-care ability and caring ability of family caregivers of male patients with first-episode depression.Methods:From March 2018 to March 2020, the convenient sampling was used to select 100 male patients with depression and 100 caregivers who were hospitalized in the First Department of Mood Disorders in the Second Affiliated Hospital of Xinxiang Medical University as the research objects. The patients and their caregivers were divided into the experimental group and the control group by the random number table method, with 50 patients and 50 caregivers in each group. The control group received routine nursing and follow-up, while the experimental group received continuous nursing intervention based on timing theory for 6 months on this basis. Hamilton Depression Scale (HAMD) , Hamilton Anxiety Scale (HAMA) , World Health Organization on Quality of Life Brief Scale (WHOQOL-BREF) , Exercise of Self-Care Agency Scale (ESCA) and Family Caregiver Task Inventory (FCTI) scale were used in the control group and the experimental group. The patients and their families were evaluated at 72 h after admission, at discharge, 3 months after discharge and 6 months after discharge.Results:After the intervention, the scores of HAMA and HAMD in the experimental group were lower than those in the control group, and the scores of each dimension of WHOQOL-BREF were higher than those in the control group, and the differences between the two groups were statistically significant ( P<0.01) . At the time of discharge, 3 months and 6 months after discharge, the total score of the FCTI scale of the caregivers in the experimental group was lower than that of the control group, and the ESCA total score of the patients was higher than that of the control group, and the differences between the two groups were statistically significant ( P<0.01) . Conclusions:Continuous nursing based on timing theory can effectively relieve anxiety and depression of male patients with first-episode depression, improve quality of life and self-care ability of patients and improve the care level of family caregivers.

Virtual monochromatic images (VMI) that reconstructed on dual-energy computed tomography (DECT) have further application prospects in radiotherapy, and there is still a lack of clinical dose verification. In this study, GE Revolution CT scanner was used to perform conventional imaging and gemstone spectral imaging on the simulated head and body phantom. The CT images were imported to radiotherapy treatment planning system (TPS), and the same treatment plans were transplanted to compare the CT value and the dose distribution. The results show that the VMI can be imported into TPS for CT value-relative electron density conversion and dose calculation. Compared to conventional images, the VMI varies from 70 to 140 keV, has little difference in dose distribution of 6 MV photon treatment plan.
Electrons ; Phantoms, Imaging ; Tomography Scanners, X-Ray Computed ; Tomography, X-Ray Computed

Background: Currently available guidelines contain conflicting recommendations on the management of blood pressure (BP) in patients with diabetes mellitus (DM). Therefore, it is necessary to appraise the guidelines and summarize the agreements and differences among recommendations. Methods: Four databases and the websites of guideline organizations were searched for guidelines regarding BP targets and thresholds for pharmacologic therapy in DM patients, and the included guidelines were appraised with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results: In 6,498 records identified, 20 guidelines met our inclusion criteria with 64.0% AGREE II scores (interquartile range, 48.5% to 72.0%). The scores of the European and American guidelines were superior to those of the Asian guidelines (both adjusted P<0.001). Most of the guidelines advocated systolic BP targets <130 mm Hg (12 guidelines, 60%) and diastolic BP targets <80 mm Hg (14 guidelines, 70%) in DM patients. Approximately half of the guidelines supported systolic BP thresholds >140 mm Hg (10 guidelines, 50%) and diastolic BP thresholds >90 mm Hg (nine guidelines, 45%). The tiny minority of the guidelines provided the relevant recommendations regarding the lower limit of official BP targets and the ambulatory BP monitoring (ABPM)/home BP monitoring (HBPM) targets and thresholds in DM patients. Conclusion The lower official BP targets (<130/80 mm Hg) in patients with DM are advocated by most of the guidelines, but they contain conflicting recommendations on the official BP thresholds. Moreover, the gaps regarding the lower limit of official BP targets and the ABPM/HBPM targets and thresholds need to be considered by future study.

Background: Currently available guidelines contain conflicting recommendations on the management of blood pressure (BP) in patients with diabetes mellitus (DM). Therefore, it is necessary to appraise the guidelines and summarize the agreements and differences among recommendations. Methods: Four databases and the websites of guideline organizations were searched for guidelines regarding BP targets and thresholds for pharmacologic therapy in DM patients, and the included guidelines were appraised with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results: In 6,498 records identified, 20 guidelines met our inclusion criteria with 64.0% AGREE II scores (interquartile range, 48.5% to 72.0%). The scores of the European and American guidelines were superior to those of the Asian guidelines (both adjusted P<0.001). Most of the guidelines advocated systolic BP targets <130 mm Hg (12 guidelines, 60%) and diastolic BP targets <80 mm Hg (14 guidelines, 70%) in DM patients. Approximately half of the guidelines supported systolic BP thresholds >140 mm Hg (10 guidelines, 50%) and diastolic BP thresholds >90 mm Hg (nine guidelines, 45%). The tiny minority of the guidelines provided the relevant recommendations regarding the lower limit of official BP targets and the ambulatory BP monitoring (ABPM)/home BP monitoring (HBPM) targets and thresholds in DM patients. Conclusion The lower official BP targets (<130/80 mm Hg) in patients with DM are advocated by most of the guidelines, but they contain conflicting recommendations on the official BP thresholds. Moreover, the gaps regarding the lower limit of official BP targets and the ABPM/HBPM targets and thresholds need to be considered by future study.

Objective To study the homology characteristics of clinicaly isolated and colonized linezolid(LZD)-resistant Enterococcus faecalis (E.faecalis) strains from a patient.Methods Ten E.faecalis strains (2 were isolated from urine specimens and 8 were from stool specimens) isolated from a patient with pulmonary infection were performed antimicrobial susceptibility testing, homology of E.faecalis was determined by pulsed-field gel electrophoresis (PFGE).Results Before and after patients received LZD therapy, 2 E.faecalis strains isolated form urine specimens were both resistant to LZD (MICs: 8 mg/mL, 16 mg/mL, respectively), among 8 strains from stool specimens (6 were isolated before therapy, and 2 were isolated after therapy), LZD susceptible, intermediate, and resistant strains were 4, 2, and 2 respectively(MICs: 0.25-12 mg/mL).10 strains of E.faecalis were homologous by PFGE typing.Conclusion In this case, the detection of E.faecalis from urinary tract and intestinal tract is homologous, which suggested that LZD-resistant Enterococcus may be colonized in vivo for a long time, and may be shift to cause bacterial infection.

Objective To understand genetic mutation sites in linezolid (LZD)-sensitive and inducible resistant strains of methicillin-resistant Staphylococcus aureus (MRSA) using whole-genome sequencing,and realize mutation sites of LZD-resistant gene.Methods MRSA-MS4 with explicit genotype and whole-genome sequences was induced by LZD of different concentration gradients,LZD-resistant strain MRSA-MS4-LZD100 was obtained,minimum inhibitory concentration(MIC) was detected,domain V of 23S rRNA and ribosomal proteins L3/L4 gene in MRSAMS4-LZD100 were amplified by polymerase chain reaction (PCR),the sequenced products obtained the corresponding mutation site in contrast with the wild-type strain;Illumina PE library was constructed through paired-end sequencing by Illumina HiSeq 2000 technique,and whole genome sequencing was completed based on bioinformatics.Results MRAS-MS4-LZD100 strain was induced after 32 passages,MIC of LZD was 96 μg/mL.Sequencing of PCR products indicated the genetic variations were G2447T mutation in multiple copies of domain V of 23S rRNA gene,and Gly113Val mutation in L3 protein respectively;the whole genome of MRSA-MS4-LZD100 contained 2 744 315 bp,annotation of the whole genome found a total of 2 509 genes,11 tRNA-encoding genes and 2 entire rRNA-encoding operons.The data were submitted to the PubMed,and the GeneBank accession number JXMJ00000000 was assigned;a total of 101 SNPs and 6 Small indels were found,16 of 101SNP mutations occurred in exon,of which the variant proteins with anmino acid sequence alterations included IstB ATP binding domain-containing protein,clumping factor A,IS1272 transposase and so on;3 of 6 Small indel mutations occurred in exon,of which the variant proteins with anmino acid sequence alterations included hypothetical protein,30S ribosomal protein S1,and clumping factor A.Conclusion LZD-resistant strain MRSA-MS4-LZD100 was successfully induced by LZD;beside 23S rRNA V domain and ribosomal L3 protein,the other mutant site exist in this resistant strain,which provide some direction for subsequent study of recessive LZD resistance mechanism.

Objective This study was designed to examine the clinical characteristics of bloodstream infections (BSI) caused by Staphylococcus aureus in a teaching hospital and the risk factors for 30-day mortality.Methods A single center retrospective cohort study was conducted for all the patients with BSI caused by S.aureus between 2008 and 2015.The data of clinical features,microbiology,and 30-day mortality were collected from the database of electronic medical records.Results A total of 121 patients with S.aureus BSI were identified.The prevalence of methicillin-resistant S.aureus (MRSA) was 17.4％ (21/121).MRSA BSIs were significantly associated with old age (≥65 years) (P=0.026),hospital acquired infection (P=0.035),respiratory tract infection (P=0.001),polyinfection (P=0.005) and inappropriate initial antibiotic therapy (P=0.001) than methicillin-sensitive S.aureus (MS SA) BSIs.The 30-day mortality was 18.2％ (22/121).Both univariate and multivariate analysis suggested that solid tumor (OR,8.932,P=0.004) and septic shock (OR,56.721,P＜0.001) were independently associated with the 30-day mortality.Conclusions The present study confirms that solid tumor and septic shock are more important risk factors than MRSA in mortality of patients with S.aureus BSI.

Objective To analyze the genomic evolution characteristics of pathogenicity islands (PAIs)in Deng strain of enteropathogenic Escherichia coli (E.coli,EPEC Deng).Methods EPEC Deng was isolated from infant stool specimen,serotypes were identified and antimicrobial susceptibility testing was performed;whole-genome se-quencing was performed by Illumina 2000 system,the locations of prophages(PPs)in the chromosome were detected using PHAST software,collinearity analysis was performed by MUMmer software,phylogenetic trees of homolo-gous gene were constructed in order to understand the evolutional rule of homology gene.PAIs prediction was per-formed using PAI finder software,the homologous evolutionary rule of PAIs core region(LEE)and core genes were clarified,genetic polymorphism was analyzed.Results The serotype of EPEC Deng strain was O119:H6,the strain was resistant to ciprofloxacin,levofloxacin,and ampicillin,but sensitive to other antimicrobial agents.The complete circular chromosome contained 5 025 482 bp with a GC content of 50.52 %,and the plasmid contained 207 564 bp with a GC content of 49.50%.A total of 17 PPs in the chromosomal genome were discovered,phyloge-netic trees analysis suggested that EPEC Deng strain was highly homologous with O26:H11 and O111 :H strains;PAIs and core genes were highly homologous with RDEC-1 and O26:H413/89-1 strains;genetic diversity analysis showed that the intimin (eae)and its receptor tir had high polymorphism,with the pi (π)value>0.10,the genes in type III secretion system was relatively stable.Conclusion The study clarified the genomic evolution characteris-tics of EPEC Deng genome and it’s PAIs,and is helpful for understanding genetic characteristics of native EPEC.