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.

Cholesterol,as an important component of cell membranes,plays a multifaceted role in mediating tumor immunomodulation and drug intervention.In case of cholesterol metabolic imbalance,the accumulation of cholesterol metabolic intermediates,the changes in concentrations,and the regulation of related signaling pathways can affect tumor immunity by promoting inflammation and inhibiting immune cell function.Preclinical and clinical studies have shown that controlling cholesterol metabolism can inhibit tumor growth,re-shape body immune regulation,and enhance antitumor immunity.A deep understanding of the association between immune cells and cholesterol metabolic pathways in the tumor microenvironment can help to develop novel drugs targeting cholesterol metabolism.This article reviews the multifaceted role of cholesterol and its derived metabolites in the tumor microenvironment by regulating various types of immune cells such as myeloid-derived suppressor cells,tumor-associated macrophages,dendritic cells,and T-lymphocytes,as well as the characteristics of tumor immunomodulation mediated by cholesterol metabolism and the advances in pharmaceutical re-search on improving the immune function of the body by intervening against cholesterol,in order to further provide new ideas and a thera-peutic basis for cholesterol modulation and intervention in tumor im-munotherapy.

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 evaluate the usability of Gafchromic HD-V2 film for dose dosimetry in the ultra-high dose-rate (UD) electron beam from a modified medical linac, and to investigate the response between the energy and dose-rate dependence to the film.Methods:The HD-V2 film was utilized to measure the average dose-rate of the UD electron beam. The measured result was compared with those by advanced Markus chamber and alanine pellets. And characteristics of the UD electron beam were also measured by HD-V2 film. Energy dependence of HD-V2 film at three beam energies (6 MV X-ray, 9 MeV and 16 MeV electron beam) was investigated by obtaining and comparing the calibration curves based on the clinical linear accelerator in the dose range of 10-300 Gy. The dose-rate dependence of HD-V2 film was also studied by varying the dose rate among 0.03 Gy/s, 0.06 Gy/s and 0.1 Gy/s, and range of 100-200 Gy/s.Results:The measured average maximum dose-rate of 9 MeV UD electron beam at source skin distance (SSD) 100 cm was approximately 121 Gy/s using HD-V2 film, consistent with the results by advanced Markus chamber and alanine pellets. The measured percentage depth dose (PDD) curve parameters of the UD electron beam were similar to the conventional 9 MeV beam. The off-axis dose distribution of the UD electron beam showed the highest central axis, and the dose was gradually decreased with the increase of off-axis distance. The energy dependence of HD-V2 film had no dependency of 6 MV and 9, 16 MeV while measuring the dose in the range from 20 to 300 Gy. The HD-V2 film had no significant dose-rate dependency at the dose rate of 0.03 Gy/s, 0.06 Gy/s and 0.1 Gy/s for the clinical linear accelerator. Likewise, there was also no dose-rate dependence in the range 100-200 Gy/s in the modified machine.Conclusion:HD-V2 film is suitable for measuring ultra-high dose rate electron beam, independent of energy and dose rate.

SIRT6 belongs to the conserved NAD⁺-dependent deacetylase superfamily and mediates multiple biological and pathological processes. Targeting SIRT6 by allosteric modulators represents a novel direction for therapeutics, which can overcome the selectivity problem caused by the structural similarity of orthosteric sites among deacetylases. Here, developing a reversed allosteric strategy AlloReverse, we identified a cryptic allosteric site, Pocket Z, which was only induced by the bi-directional allosteric signal triggered upon orthosteric binding of NAD⁺. Based on Pocket Z, we discovered an SIRT6 allosteric inhibitor named JYQ-42. JYQ-42 selectively targets SIRT6 among other histone deacetylases and effectively inhibits SIRT6 deacetylation, with an IC₅₀ of 2.33 μmol/L. JYQ-42 significantly suppresses SIRT6-mediated cancer cell migration and pro-inflammatory cytokine production. JYQ-42, to our knowledge, is the most potent and selective allosteric SIRT6 inhibitor. This study provides a novel strategy for allosteric drug design and will help in the challenging development of therapeutic agents that can selectively bind SIRT6.

Objective:To search and summarize the relevant evidences for perioperative hydration in prevention of contrast-induced acute kidney injury (CIAKI) in patients undergoing coronary intervention, and to provide evidence-based basis for clinical nursing staff to develop personalized perioperative hydration plan and prevent CIAKI.Methods:Evidence-based nursing was used to search evidences for perioperative hydration in prevention of CIAKI in patients undergoing coronary intervention in UpToDate, National Guideline Clearing-house (NGC) , European Society of Cardiology (ESC) , JBI Evidence Summary Database, Cochrane Database, PubMed, Wanfang Database, China National Knowledge Infrastructure (CNKI) and China Biomedical Literature Database (CBM) , including evidence summary, guidelines, expert consensus and systematic reviews. The search time was from the establishment of the database to February 2019. Two researchers evaluated the quality of included literatures and extracted evidence from literatures that met the quality standards.Results:A total of 9 articles of evidence were included, including 1 evidence summary, 3 guidelines, 3 expert consensus and 2 systematic evaluations. Finally, a total of 10 pieces of evidence from 5 aspects, including CIAKI risk assessment, hydration fluid type, hydration path and timing, hydration rate and urine volume monitoring, were summarized.Conclusions:This study summarizes the best evidence for perioperative hydration in prevention of CIAKI in patients undergoing coronary intervention and provides an evidence-based basis for clinical medical staff.

Objective:Based on the AAPM-TG218 report, the dose verification of intensity-modulated radiotherapy (IMRT) plans were classified to understand the current status, establish the process and determine the limits of dose verification in our hospital.Methods:Different combinations of tumor locations, accelerators, treatment planning systems and verification devices in our hospital were verified and compared to determine the tolerance limits and action limits of each combination. The measurement requirement was adopted according to the AAPM-TG218 report, and 80 cases were selected for each measurement. The measurement procedures were implemented based upon the AAPM-TG218 report and clinical experience of our hospital.Results:The clinical action limits of IMRT plans in our hospital could meet the recommended range of the AAPM-TG218 report, and the tolerance limits were slightly lower than the AAPM-TG218 report′s recommendation (93.94% for 3%/2 mm). The measurement of verification devices was related to the sensitivity. The tolerance limits measured by EPID were higher than ArcCHECK, especially when the dose/distance requirements were more stringent (94.12% and 92.03% for 3%/2 mm, P=0.074; 86.82% and 74.61% for 2%/2 mm, P=0.017). Conclusion:Through the AAPM-TG218 report, the work flow of IMRT dose verification and the limit range are established in our hospital, providing guidance for subsequent clinical dosimetric measurement.

Objective:To validate the accuracy of physical model of in-vivo 3D dose verification based on electronic portal imaging device (EPID) using the phantom and preliminarily analyze the clinical application.Methods:Two phantoms (uniform and non-uniform phantoms) were involved in this study. The system of in-vivo 3D dose verification based on EPID was employed to acquire the images of square fields (SF) and combined fields of intensity-modulated radiotherapy (CFIMRT). The physical model of different media was constructed using the system. The factor of γ passing rate under different dose/distance criteria was statistically compared. For clinical cases, the dose-volume histograms were adopted to analyze the dose distribution of target volume and organs at risk (OARs).Results:For the SF in the uniform phantom, the average γ passing rate (3%/3 mm) was (97.49±1.11)%, and (94.06±5.11)% for the SF in the non-uniform phantom ( P>0.05). No statistical significance was noted in IMRT using different delivery methods (all P>0.05). For clinical cases, the average γ passing rate (3%/2 mm) was (97.96±1.84)% in the pre-treatment dose verification, and (90.51±6.96)%(3%/3 mm) for the in-vivo 3D dose verification. For clinical cases, significant dose deviation was observed in OARs with small size and large volume changes. Conclusion:The in-vivo 3D dose verification model based on EPID can be effectively applied in inter-fraction dose verification, providing technical support for adaptive radiotherapy in clinical practice.

Objective:To build a systemic and automatic importing scheme for importing CT images and structures into the treatment planning systems (TPSs) of Eclipse and Monaco.Methods:Based on two TPSs of Eclipse and Monaco, the files of CT images and structures were automatically transported from OAR auto-delineation system to the importing directory of these two TPSs using batch script in Windows system. Following the standard importing procedures of these two TPSs, the automatically importing script of CT images and structures were developed using the application of UiBot. Finally, the CT images and structures were imported into these two TPSs opportunely.Results:By comparing the importing time using script and manual methods, the script not only achieved auto-importing CT images and structures into TPSs, but also yielded almost the same efficiency to manual method. The number of imaging layers in most patients was between 130 and 180, and the average manual and automatic importing time within this interval was 76 s and 75 s.Conclusions:Automatic scripts can be developed by using the automation function of UiBot combined with the actual problems of radiotherapy and repeated workflow. The efficiency of radiotherapy work can be significantly improved. Manual and time costs can be saved. It provides a novel alternative for the automation of radiotherapy procedures.

Objective To evaluate the effect of calcitriol combined with losartan on diabetic nephropathy in grade Ⅲ and early Ⅳ.Methods 47 patients with diabetic nephropathy were enrolled.Patients were randomly assigned to receive losartan or both losartan and calcitriol according to randomized table for 6 months.At baseline time and after 6 months,the 24-hour urinary protein excretion,estimated glomerular filtration rate (eGFR),serum creatinine(SCr),blood pressure,fasting blood-glucose,serum calcium,serum phosphorus,pulse wave velocity(PWV) and ankle brachial index(ABI) were measured.Results The urinary protein excretion showed that there was significant decrease in the mix-treated group[(824.81 ± 307.84) g/24h vs (390.75 ± 173.51) g/24h,t =10.51,P ＜ 0.01] and the control group [(860.64 ± 313.89) g/24h vs (676.16 ± 297.71)g/24h,t =6.91,P ＜ 0.01].Furthermore,the mix-treated group had the lower proteinuria compared the group given losartan only(t =2.56,P =0.015).No significant differences were observed decrease in estimated eGFR and change in serum calcium,serum phosphorus,PWV and ABI between the two groups.Conclusion Addition of calcitriol to a renin-angiotensin system inhibitor resulted in a safe decrease in proteinuria in patients with diabetic nephropathy.