Objective To introduce the causes of accidents and the diagnosis and treatment of two patients with radiation-induced skin injury admitted to our hospital in 2023, and to provide a reference for the clinical treatment of subsequent radiation-induced skin injury. Methods The clinical treatment process of two patients with acute skin injury caused by external radiation exposure were summarized and analyzed. Results The exposure history of the two patients was reconstructed, the flaw detection scenario was simulated, the biological dose and hand skin exposure dose were estimated, and the infrared thermal imaging device was used for dynamic monitoring. A comprehensive analysis was conducted based on clinical manifestations and other data. The diagnosis of “Xie” was excessive exposure combined with acute radiation-induced skin injury on both hands (Grade IV for the right hand palm, index finger, and middle finger and Grade II for the left hand little finger). The diagnosis of “Hao” was acute radiation-induced skin injury on both hands (Grade I). The two patients received different clinical treatment measures: “Xie” was treated with both local and systemic therapies, while “Hao” was mainly treated with systemic therapy. Conclusion After systematic and effective treatment, the radiation-induced skin injuries healed in both patients.

Heart failure （HF） is the end stage of various cardiovascular diseases， manifested as ventricular filling or impaired left ventricular ejection fraction （LVEF）. Type 2 diabetes mellitus （T2DM） is a metabolic disorder， mainly caused by insufficient insulin secretion and insulin resistance. The incidence rates of the two common clinical diseases are increasing year by year. HF and T2DM are mutually causal chronic diseases， and their mutual deterioration can form a HF-T2DM comorbidity. The comorbidity status significantly increases the mortality and readmission risk of patients， and seriously affects the quality of life of patients. At present， western medicine treatment mainly involves the use of anti HF drugs and hypoglycemic drugs， which can significantly alleviate the clinical symptoms of patients. However， these two categories of drugs are numerous in variety and differ in their mechanisms， and blind combination may produce adverse reactions. With its unique theoretical system， traditional Chinese medicine exhibits the advantages of multiple components， multiple targets， and high safety through traditional Chinese medicine monomers， Chinese patent medicine， traditional Chinese medicine compounds， and acupuncture， which significantly delays the development of HF-T2DM and shows great potential in clinical treatment. A large number of clinical studies have shown that the integrated traditional Chinese and western medicine in the treatment of HF-T2DM has a significant effect in improving cardiac function， controlling blood glucose levels， and improving the quality of life of patients. Based on relevant research at home and abroad， this paper reviewed the HF-T2DM pathogenesis， pharmacological effects， research status of traditional Chinese and western medicine， and early prevention strategies， and discussed current problems and future research directions， in order to provide new ideas and useful references for clinical prevention and treatment of HF-T2DM.

Heart failure （HF） is the end stage of various cardiovascular diseases， manifested as ventricular filling or impaired left ventricular ejection fraction （LVEF）. Type 2 diabetes mellitus （T2DM） is a metabolic disorder， mainly caused by insufficient insulin secretion and insulin resistance. The incidence rates of the two common clinical diseases are increasing year by year. HF and T2DM are mutually causal chronic diseases， and their mutual deterioration can form a HF-T2DM comorbidity. The comorbidity status significantly increases the mortality and readmission risk of patients， and seriously affects the quality of life of patients. At present， western medicine treatment mainly involves the use of anti HF drugs and hypoglycemic drugs， which can significantly alleviate the clinical symptoms of patients. However， these two categories of drugs are numerous in variety and differ in their mechanisms， and blind combination may produce adverse reactions. With its unique theoretical system， traditional Chinese medicine exhibits the advantages of multiple components， multiple targets， and high safety through traditional Chinese medicine monomers， Chinese patent medicine， traditional Chinese medicine compounds， and acupuncture， which significantly delays the development of HF-T2DM and shows great potential in clinical treatment. A large number of clinical studies have shown that the integrated traditional Chinese and western medicine in the treatment of HF-T2DM has a significant effect in improving cardiac function， controlling blood glucose levels， and improving the quality of life of patients. Based on relevant research at home and abroad， this paper reviewed the HF-T2DM pathogenesis， pharmacological effects， research status of traditional Chinese and western medicine， and early prevention strategies， and discussed current problems and future research directions， in order to provide new ideas and useful references for clinical prevention and treatment of HF-T2DM.

ObjectiveTo explore the factors influencing home-based rehabilitation exercise and the needs for digital interventions among patients with spinal muscular atrophy (SMA), based on the behavior change wheel (BCW), and to provide evidence for the development of digital home-based rehabilitation interventions. MethodsA two-phase qualitative study was conducted from December, 2024 to March, 2025. Using convenience sampling, 14 participants were recruited, including patients with SMA, primary caregivers, rehabilitation professionals, clinicians, a patient organization representative and a health policy expert. In phase 1, semi-structured individual interviews were conducted with seven participants, including patients, caregivers and a patient organization representative, to identify factors influencing home-based rehabilitation exercise and unmet needs. In phase 2, a focus group involving 12 stakeholders was conducted, including five participants who had participated in phase 1, to explore requirements for the functions, knowledge content and interface design of a digital intervention, five of them had participated in phase 1. Overall, the two phases involved 14 individual participants, accounting for 19 participant-instances. Thematic analysis was performed using both deductive and inductive approaches, guided by the capability-opportunity-motivation-behavior (COM-B) model. ResultsSix themes were identified. phase 1 showed that patients with SMA experienced inadequate continuity of rehabilitation services and limited access to professional rehabilitation resources, with interruptions in institution-based rehabilitation coexisting with declining adherence to home-based exercise. Home-based rehabilitation exercise was jointly influenced by capability-, opportunity- and motivation-related factors, including limited capabilities of patients and caregivers, constraints in time and supportive conditions and insufficient goals, feedback, and incentives. Individualized rehabilitation plans and professional guidance were the major unmet needs. phase 2 showed that the core functions of a digital intervention should include individualized exercise plans, professional guidance and feedback, reminders and incentives, safety monitoring, remote assessment, and privacy and permission management. Core knowledge content should include stratified exercise guidance, caregiving skills, recognition of abnormal conditions, and information on when and how to seek help. The interface should be simple, impose a low user burden and accommodate different types of users. ConclusionHome-based rehabilitation exercise among patients with SMA is jointly influenced by multiple capability-, opportunity- and motivation-related factors. Digital interventions should prioritize individualized rehabilitation plans, professional guidance and sustained behavioral support. These findings may inform the development of a digital home-based rehabilitation intervention prototype for patients with SMA; its feasibility, safety, clinical effectiveness and economic value require further evaluation.

Objective To observe the impact of sublingual nitroglycerin(NTG)on imaging quality of non-contrast MR coronary angiography(NMRCA).Methods Thirty patients with suspected coronary heart disease(CHD)who would undergo coronary angiography(CAG)examination were prospectively collected.NMRCA images were acquired before and after sublingual NTG.Clinical meaningful stenosis was defined as CAG showed luminal stenosis ≥50％.Then imaging quality scores,diameters and display length of coronary arteries,as well as the impact of NTG on diagnostic performances of NMRCA for coronary artery stenosis were compared between images before and after administration of NTG.Results After administration of NTG,image quality of left main(LM)-left anterior descending artery(LAD)and left circumflex artery(LCX),as well as the proximal,mid and distal segments of LAD and distal segment of LCX significantly improved(all P＜0.05).No significant difference of visible coronary artery length was noticed before and after administration of NTG(all P＞0.05).After administration of NTG,diameter of right coronary artery(RCA),LM-LAD and LCX increased(all P＜0.05),with dilation rate of 16.23％(13.57％,19.17％),17.52％(12.69％,21.11％)and 14.30％(7.62％,23.22％),respectively,while the sensitivity,specificity,accuracy and negative predictive value of NMRCA for diagnosing coronary artery stenosis improved(all P＜0.05).Conclusion Sublingual NTG could improve imaging quality of NMRCA and increase its efficacy for diagnosing coronary artery stenosis.

Wilson's disease(WD)is an autosomal recessive inherited copper metabolism disorder that can cause myocardial damage,but the sensitivity of electrocardiography and echocardiography in detecting WD myocardial injury is limited.In recent years,cardiac magnetic resonance has been widely used for non-invasive identification of myocardial damage.Cardiac magnetic resonance,through cine imaging,can detect ventricular remodeling and decreased cardiac function in WD patients,as well as identify myocardial fissures;strain imaging can detect subclinical myocardial contractile dysfunction in WD patients;delayed enhancement can assess myocardial fibrosis in WD patients;Mapping techniques can quantitatively detect myocardial edema,inflammation and fibrosis in WD patients,providing a comprehensive non-invasive assessment of WD myocardial damage and offering important information for understanding the mechanism of myocardial injury in WD.This article reviews the research progress of cardiac magnetic resonance in WD myocardial damage.

Objectives:To evaluate the incidence of neurological complications following left ventricular assist device(LVAD)implantation and to investigate related risk factors.Methods:A retrospective analysis was conducted on 151 patients who underwent LVAD implantation at Fuwai Hospital between June 2017 and September 2024.Clinical characteristics and postoperative survival outcomes were compared between patients with and without neurological complications.Results:Neurological complications occurred in 21 patients(13.9%)postoperatively,15 cases were ischemic strokes,5 cases were symptomatic intracranial hemorrhages or subarachnoid hemorrhages,and 1 case was transient ischemic attack(TIA).The total incidence of neurological complications was 0.08 events per person-year(EPPY),ischemic stroke was 0.06 EPPY and hemorrhagic stroke was 0.02 EPPY.Compared with patients without neurological complications,patients with neurological complications had a higher proportion of preoperative aortic regurgitation and tricuspid regurgitation,lower triglyceride levels,a lower rate of concurrent left atrial appendage resection and a higher rate of concurrent aortic valve replacement surgery.Multivariate cox regression analysis revealed that higher preoperative triglyceride levels(HR=0.21,95%CI:0.08-0.56,P=0.002)were associated with neurological complications.The median follow-up time was 508.0(186.5,931.5)days,12 out of 15 cases of ischemic stroke experienced no long-term sequelae,while 3 patients had varying degrees of residual deficits.All 5 patients with hemorrhagic stroke died,with 2 deaths directly attributed to hemorrhage.Kaplan-Meier survival curve analysis indicated that patients with neurological complications had a significantly lower survival rate(log-rank P=0.005).Conclusions:Neurological complications after LVAD implantation are predominantly ischemic strokes.Although less frequent,hemorrhagic strokes are associated with worse outcomes.Higher preoperative triglyceride levels is associated with neurological complications.

Objective:In carbon ion treatment planning of water phantom, establish a conversion factor calculation system and conversion factor curves for organs at risk (OAR) for microdosimetric kinetic models (MKM) and local effect models (LEM), and validate them in clinical patient planning.Methods:Using a uniform spherical water phantom as the research object, relative biological effectiveness-weighted doses (RWD) for the LEM were re-calculated based on the physical dose of RayStation-MKM. The median dose within the planning target volume (PTV) of LEM and MKM was regarded as the conversion factor. The impacts of single-fraction target prescription dose, spread-out Bragg peak (SOBP) width and depth, shape, and irradiation mode on the conversion factor were assessed, and a conversion factor calculation system was established. Additionally, the accuracy of the conversion factor calculation system was validated using both water phantoms and clinical patient cases. The conversion factor curves for OAR were computed based on clinical patient treatment plans.Results:The primary influencing factors for the conversion factors were the single-fraction prescription dose, target SOBP width and depth. The conversion factors were increased with the increase of SOBP width and target depth, whereas decreased with the increase of the single-fraction prescription dose. Under single-field irradiation, a conversion factor calculation system was established based on above 3 parameters. For the plans of 9 patients, the average difference between the calculated results and the conversion factor calculation system was 0.340% ± 0.203%, and the average difference in the conversion curves for OAR was 2.650% ± 2.399%.Conclusion:A dose conversion factor calculation system and conversion factor curves for OAR for carbon ion radiotherapy are established for MKM and LEM, and their accuracy meets the requirements for use in clinical patient treatment plans.

Objective To observe the impact of sublingual nitroglycerin(NTG)on imaging quality of non-contrast MR coronary angiography(NMRCA).Methods Thirty patients with suspected coronary heart disease(CHD)who would undergo coronary angiography(CAG)examination were prospectively collected.NMRCA images were acquired before and after sublingual NTG.Clinical meaningful stenosis was defined as CAG showed luminal stenosis ≥50％.Then imaging quality scores,diameters and display length of coronary arteries,as well as the impact of NTG on diagnostic performances of NMRCA for coronary artery stenosis were compared between images before and after administration of NTG.Results After administration of NTG,image quality of left main(LM)-left anterior descending artery(LAD)and left circumflex artery(LCX),as well as the proximal,mid and distal segments of LAD and distal segment of LCX significantly improved(all P＜0.05).No significant difference of visible coronary artery length was noticed before and after administration of NTG(all P＞0.05).After administration of NTG,diameter of right coronary artery(RCA),LM-LAD and LCX increased(all P＜0.05),with dilation rate of 16.23％(13.57％,19.17％),17.52％(12.69％,21.11％)and 14.30％(7.62％,23.22％),respectively,while the sensitivity,specificity,accuracy and negative predictive value of NMRCA for diagnosing coronary artery stenosis improved(all P＜0.05).Conclusion Sublingual NTG could improve imaging quality of NMRCA and increase its efficacy for diagnosing coronary artery stenosis.

Objectives:To evaluate the incidence of neurological complications following left ventricular assist device(LVAD)implantation and to investigate related risk factors.Methods:A retrospective analysis was conducted on 151 patients who underwent LVAD implantation at Fuwai Hospital between June 2017 and September 2024.Clinical characteristics and postoperative survival outcomes were compared between patients with and without neurological complications.Results:Neurological complications occurred in 21 patients(13.9%)postoperatively,15 cases were ischemic strokes,5 cases were symptomatic intracranial hemorrhages or subarachnoid hemorrhages,and 1 case was transient ischemic attack(TIA).The total incidence of neurological complications was 0.08 events per person-year(EPPY),ischemic stroke was 0.06 EPPY and hemorrhagic stroke was 0.02 EPPY.Compared with patients without neurological complications,patients with neurological complications had a higher proportion of preoperative aortic regurgitation and tricuspid regurgitation,lower triglyceride levels,a lower rate of concurrent left atrial appendage resection and a higher rate of concurrent aortic valve replacement surgery.Multivariate cox regression analysis revealed that higher preoperative triglyceride levels(HR=0.21,95%CI:0.08-0.56,P=0.002)were associated with neurological complications.The median follow-up time was 508.0(186.5,931.5)days,12 out of 15 cases of ischemic stroke experienced no long-term sequelae,while 3 patients had varying degrees of residual deficits.All 5 patients with hemorrhagic stroke died,with 2 deaths directly attributed to hemorrhage.Kaplan-Meier survival curve analysis indicated that patients with neurological complications had a significantly lower survival rate(log-rank P=0.005).Conclusions:Neurological complications after LVAD implantation are predominantly ischemic strokes.Although less frequent,hemorrhagic strokes are associated with worse outcomes.Higher preoperative triglyceride levels is associated with neurological complications.