Objective:To investigate human factors underlying radiotherapy planning safety incidents and quantitatively explore their interrelationships.Methods:A total of 1 619 safety incidents recorded in the automated plan checking system developed by West China Hospital of Sichuan University were utilized. Human factors were identified and statistically analyzed using the Human Factors Analysis and Classification System (HFACS). A Bayesian network model was developed and combined with sensitivity analysis for quantitative assessment.Results:Key contributing factors included organizational processes (12.89%), inadequate supervision (11.85%), and personnel factors (13.50%). Utilizing the established HFACS Bayesian network hybrid model in conjunction with sensitivity analysis, it has been found that the most significant influences on skill‐based errors and decision errors were condition of operators and environmental factors, with corresponding indices of 0.96 and 0.76. Additionally, personnel factors had the greatest impact on routine, with an index of 3.51.Conclusions:Key contributing factors span all HFACS levels, with organizational processes, supervision, personnel, and condition of operators each playing a significant role. Upstream factors — such as organizational climate, environment factors, and personnel factors — strongly influence downstream risks. These offer actionable insights for developing targeted safety protocols.

Objective:To explore the efficacy of the fifth metatarsal perforator flap of the lateral plantar artery in repairing the wounds on the anterolateral side of the foot.Methods:This study was a retrospective observational study. Eight patients with skin and soft tissue defects on the anterolateral side of the foot and conformed to the inclusion criteria were admitted to the Department of Plastic Surgery of Hanzhong Central Hospital from July 2020 to July 2023. There were 6 males and 2 females, aged 22 to 72 years. Among the patients, there were three patients with electrical burns, four patients with trauma, and one patient with plantar wart. Preoperatively, a Doppler blood flow detector was used to clarify the number and location of the fifth metatarsal perforating vessels. The area of the wounds measured during the operation ranged from 4.0 cm×3.0 cm to 7.0 cm×5.0 cm, and the fifth metatarsal perforator flaps of the lateral plantar artery with area of 4.0 cm×4.0 cm to 9.0 cm×6.0 cm were designed and harvested to repair the wounds. The wounds in the flap donor sites were repaired with medium-thickness skin grafts from lower limb on the same side. The duration of surgery and intraoperative blood loss volume were recorded. The survivals of the transplanted flap and skin graft were observed after surgery. At the last follow-up, the appearance of the flap and the occurrence of complication were observed, the two-point discrimination distance of the flap was measured, and the shape of the flap donor site as well as the sensation and other functions of the affected foot were observed.Results:The duration of surgery ranged from 70 to 100 min, with an average of 84.6 min. The intraoperative blood loss volume ranged from 30 to 80 mL, with an average of 53.5 mL. After surgery, all flaps survived completely; only one patient developed partial necrosis of the skin graft in the wound in flap donor site, and the wound healed completely after dressing change and re-grafting medium-thickness skin graft from lower limb on the same side. Postoperative follow-up was conducted for 6 to 24 months, with an average of 13.8 months. At the last follow-up, none of the patients developed bloated and deformed flaps or pressure ulcers, and the two-point discrimination distance of the flap ranged from 5 to 13 mm. No tendon adhesion or scar hyperplasia was observed in the flap donor sites, and the sensation, weight-bearing, and walking functions of the affected feet were normal.Conclusions:The use of the fifth metatarsal perforator flap of the lateral plantar artery for repairing the wounds on the anterolateral side of the foot has the advantages of flexible flap design, minimal damage to the flap donor site, simple and feasible surgical operation, and good postoperative foot appearance and function, which is worthy of clinical application and promotion.

Objective:To explore the effectiveness of outcome-oriented TECK teaching in the standardized training of neurology resident physicians, and to evaluate its impact on clinical practice, clinical thinking, and self-learning abilities.Methods:A controlled study design was adopted, and 78 resident physicians who rotated through the Department of Neurology at Guangdong Provincial People's Hospital Affiliated to Southern Medical University between November 2022 and November 2024 were divided into a control group ( n=39) and an experimental group ( n=39) according to their admission order. The control group received the traditional "theoretical teaching, rotation training, exit assessment" mode. The experimental group received an outcome-oriented TECK teaching mode, which included four modules: theoretical class, experimental course/practice, case discussion, and knowledge reinforcement. The two groups of residents were evaluated for clinical practice ability, clinical thinking ability, and teaching satisfaction. SPSS 22.0 was used for t-test and chi-square test. Results:The experimental group outperformed the control group in all dimensions of clinical practice ability (except for doctor-patient communication ability) (all P<0.001), such as basic operational skills [(4.42±0.41) vs. (3.87±0.56)] and emergency management ability [(4.38±0.39) vs. (3.65±0.62)]. The clinical thinking ability scores of the experimental group were higher (all P<0.001), such as diagnostic logic [(4.43±0.38) vs. (3.92±0.51)] and decision-making basis [(4.45±0.42) vs. (3.78±0.63)]. In terms of self-learning ability, the experimental group showed significant improvements in literature search [(4.42±0.43) vs. (3.65±0.58)] and knowledge update [(4.38±0.39) vs. (3.42±0.61)] (both P<0.001). In terms of teaching satisfaction, the experimental group scored higher in dimensions such as course design [(4.42±0.41) vs. (3.89±0.58)] and clinical fit [(4.45±0.37) vs. (3.82±0.61)] (all P<0.001). Conclusions:The outcome-oriented TECK teaching mode can effectively enhance the clinical practice and thinking abilities of neurology residents in standardized training, and improve the effectiveness of self-learning, providing an innovative path for the training of specialized physicians. In the future, interdisciplinary integration and long-term tracking and evaluation need to be optimized.

Objective:To explore the effectiveness of outcome-oriented TECK teaching in the standardized training of neurology resident physicians, and to evaluate its impact on clinical practice, clinical thinking, and self-learning abilities.Methods:A controlled study design was adopted, and 78 resident physicians who rotated through the Department of Neurology at Guangdong Provincial People's Hospital Affiliated to Southern Medical University between November 2022 and November 2024 were divided into a control group ( n=39) and an experimental group ( n=39) according to their admission order. The control group received the traditional "theoretical teaching, rotation training, exit assessment" mode. The experimental group received an outcome-oriented TECK teaching mode, which included four modules: theoretical class, experimental course/practice, case discussion, and knowledge reinforcement. The two groups of residents were evaluated for clinical practice ability, clinical thinking ability, and teaching satisfaction. SPSS 22.0 was used for t-test and chi-square test. Results:The experimental group outperformed the control group in all dimensions of clinical practice ability (except for doctor-patient communication ability) (all P<0.001), such as basic operational skills [(4.42±0.41) vs. (3.87±0.56)] and emergency management ability [(4.38±0.39) vs. (3.65±0.62)]. The clinical thinking ability scores of the experimental group were higher (all P<0.001), such as diagnostic logic [(4.43±0.38) vs. (3.92±0.51)] and decision-making basis [(4.45±0.42) vs. (3.78±0.63)]. In terms of self-learning ability, the experimental group showed significant improvements in literature search [(4.42±0.43) vs. (3.65±0.58)] and knowledge update [(4.38±0.39) vs. (3.42±0.61)] (both P<0.001). In terms of teaching satisfaction, the experimental group scored higher in dimensions such as course design [(4.42±0.41) vs. (3.89±0.58)] and clinical fit [(4.45±0.37) vs. (3.82±0.61)] (all P<0.001). Conclusions:The outcome-oriented TECK teaching mode can effectively enhance the clinical practice and thinking abilities of neurology residents in standardized training, and improve the effectiveness of self-learning, providing an innovative path for the training of specialized physicians. In the future, interdisciplinary integration and long-term tracking and evaluation need to be optimized.

Objective:To explore the efficacy of the fifth metatarsal perforator flap of the lateral plantar artery in repairing the wounds on the anterolateral side of the foot.Methods:This study was a retrospective observational study. Eight patients with skin and soft tissue defects on the anterolateral side of the foot and conformed to the inclusion criteria were admitted to the Department of Plastic Surgery of Hanzhong Central Hospital from July 2020 to July 2023. There were 6 males and 2 females, aged 22 to 72 years. Among the patients, there were three patients with electrical burns, four patients with trauma, and one patient with plantar wart. Preoperatively, a Doppler blood flow detector was used to clarify the number and location of the fifth metatarsal perforating vessels. The area of the wounds measured during the operation ranged from 4.0 cm×3.0 cm to 7.0 cm×5.0 cm, and the fifth metatarsal perforator flaps of the lateral plantar artery with area of 4.0 cm×4.0 cm to 9.0 cm×6.0 cm were designed and harvested to repair the wounds. The wounds in the flap donor sites were repaired with medium-thickness skin grafts from lower limb on the same side. The duration of surgery and intraoperative blood loss volume were recorded. The survivals of the transplanted flap and skin graft were observed after surgery. At the last follow-up, the appearance of the flap and the occurrence of complication were observed, the two-point discrimination distance of the flap was measured, and the shape of the flap donor site as well as the sensation and other functions of the affected foot were observed.Results:The duration of surgery ranged from 70 to 100 min, with an average of 84.6 min. The intraoperative blood loss volume ranged from 30 to 80 mL, with an average of 53.5 mL. After surgery, all flaps survived completely; only one patient developed partial necrosis of the skin graft in the wound in flap donor site, and the wound healed completely after dressing change and re-grafting medium-thickness skin graft from lower limb on the same side. Postoperative follow-up was conducted for 6 to 24 months, with an average of 13.8 months. At the last follow-up, none of the patients developed bloated and deformed flaps or pressure ulcers, and the two-point discrimination distance of the flap ranged from 5 to 13 mm. No tendon adhesion or scar hyperplasia was observed in the flap donor sites, and the sensation, weight-bearing, and walking functions of the affected feet were normal.Conclusions:The use of the fifth metatarsal perforator flap of the lateral plantar artery for repairing the wounds on the anterolateral side of the foot has the advantages of flexible flap design, minimal damage to the flap donor site, simple and feasible surgical operation, and good postoperative foot appearance and function, which is worthy of clinical application and promotion.

Objective:To investigate human factors underlying radiotherapy planning safety incidents and quantitatively explore their interrelationships.Methods:A total of 1 619 safety incidents recorded in the automated plan checking system developed by West China Hospital of Sichuan University were utilized. Human factors were identified and statistically analyzed using the Human Factors Analysis and Classification System (HFACS). A Bayesian network model was developed and combined with sensitivity analysis for quantitative assessment.Results:Key contributing factors included organizational processes (12.89%), inadequate supervision (11.85%), and personnel factors (13.50%). Utilizing the established HFACS Bayesian network hybrid model in conjunction with sensitivity analysis, it has been found that the most significant influences on skill‐based errors and decision errors were condition of operators and environmental factors, with corresponding indices of 0.96 and 0.76. Additionally, personnel factors had the greatest impact on routine, with an index of 3.51.Conclusions:Key contributing factors span all HFACS levels, with organizational processes, supervision, personnel, and condition of operators each playing a significant role. Upstream factors — such as organizational climate, environment factors, and personnel factors — strongly influence downstream risks. These offer actionable insights for developing targeted safety protocols.

Currently, whole uterus and bilateral tubal resection and oophorectomy is the main treatment of cervical mullerian adenosarcoma. However, young patients generally wish to retain reproductive function. The clinical data of a patient with cervical mullerian adenosarcoma, who underwent fertility preservation surgery were collected. A 13-year-old girl with abnormal vaginal bleeding and a 1.0 cm flocculent echogenicity in the lower part of the uterine cavity to the cervical canal and a cervical mass of about 61 mm×37 mm was found in the pelvic MRI. After initial diagnosis of dysfunctional uterine bleeding in adolescence and cervical blood clot, the patient was treated with artificial cycle treatment, but her symptoms did not improve. Then she was transferred to the Third Xiangya Hospital of Central South University for uninjured virgin membrane hysteroscopy and cervical mass electrotomy, but a few pedicles remained after the operation, and the pathology suggested a cervical mullerian adenosarcoma. Because the patient was young and had not yet given birth, she was treated with primary IAP regimen of chemotherapy and subcutaneously injected with gonadotropin-releasing hormone analogue (GNRH-A) once every 28 days (6 times in total) to protect the ovarian function. After the chemotherapy, she was treated with uninjured virgin membrane hysteroscopy and pedicle electrotomy of cervical mullerian adenosarcoma. After the operation, she received chemotherapy with IAP regimen for 5 times. After discharge, she was treated with megestrol 200 mg per day for 3 years. During 5 years of regular follow-up, no abnormality was seen. Cervical mullerian adenosarcoma in non-sexual women is easily misdiagnosed as ovulation dysfunction abnormal uterine bleeding. The necessity of hysteroscopy should be emphasized, and for patients with low-grade early-stage lesions who wish to retain fertility, local resection could be chosen, but attention is paid to lifelong follow-up to exclude long-term recurrence.
Humans ; Female ; Adolescent

Objective:To evaluate the role of endoplasmic reticulum stress in myocardial ischemia-reperfusion (I/R) injury and the relationship with autophagy in rats.Methods:Thirty-six healthy adult male Sprague-Dawley rats, weighing 250-300 g, were divided into 3 groups ( n=12 each) using a random number table method: sham operation group (Sham group), myocardial I/R group (IR group), and endoplasmic reticulum stress inhibitor 4-PBA group (PBA group). Myocardial I/R was produced by occlusion of left anterior descending branch of coronary artery for 30 min followed by reperfusion for 120 min.Sham group only underwent thoracotomy without block of left anterior descending branch of coronary artery.Endoplasmic reticulum stress inhibitor 4-PBA 500 mg·kg -1·d -1 was given intragastrically for 3 consecutive days before the I/R model was developed in PBA group, while the equal volume of normal saline was given instead in Sham and IR groups.The blood samples from the iliac vein were collected at 120 min of reperfusion for determination of the plasma creatine kinase isoenzymes (CK-MB) and cardiac troponin I (cTnI) concentrations (by enzyme-linked immunosorbent assay). The rats were then sacrificed, and myocardial tissues were removed for detection of myocardial glucose-regulated protein 78 (GRP78) and microtubule-associated protein 1 light chain 3 Ⅱ (LC3 Ⅱ) and autophagy-related protein 5 (ATG5) expression (by Western blot). Result:Compared with Sham group, the concentrations of CK-MB and cTnI in plasma were significantly increased in IR and PBA groups, the expression of GRP78, ATG5 and LC3Ⅱ was up-regulated, and the pathological damage was aggravated in IR group ( P<0.05). Compared with IR group, the concentrations of CK-MB and cTnI in plasma were significantly decreased, the expression of GRP78, ATG5 and LC3Ⅱ was down-regulated ( P<0.05), and the pathological changes were significantly attenuated in PBA group. Conclusion:Endoplasmic reticulum stress is involved in the process of myocardial I/R injury, and the mechanism may be related to promotion of autophagy in rats.

OBJECTIVE：To prepare paclit axel and schisandrin B liposomes modified by cell penetrating peptide RPV ，and to preliminarily evaluate its anti-tumor activity in vitro . METHODS ：RPV modified paclitaxel and schisandrin B liposomes were prepared by film dispersion method. Box-Benhken design-response surface methodology was used to optimize the prescription technology of RPV modified paclitaxel and schisandrin B liposomes using the amount of cholesterol and paclitaxel ，the time interval of ultrasound probe as factors ，average entrapment efficiency of paclitaxel and schisandrin B was used as the index. The liposomes prepared by the optimal technology were characterized. Sulfonylrhodamine B staining method was used to investigate in vitro toxicity of RPV modified blank liposomes ，paclitaxel and schisandrin B liposomes ，RPV modified paclitaxel and schisandrin B liposomes to human ovarian cancer cell SK-OV- 3. The effects of 3 kinds of liposomes on the migration and invasion ability of SK-OV-3 cells were investigated by cell scratch test and Transwell chamber invasion test. RESULTS ：The optimal prescription technology was phospholipid 44 mg，cholesterol 8 mg，paclitaxel 0.64 mg，schisandrin B 1.5 mg，ultrasonic probe time interval 5 s，prescription dosage 5 mL. According to the optimal prescription technology ，the liposomes were spherical in shape ，and the particle size was （126.49±1.19）nm，Zeta-potential was （－4.83±0.61）mV，average entrapment efficiency of liposomes was （93.88±1.67）％. Compared with RPV modified blank liposomes ，after treated with paclitaxel and schisandrin B liposomes and RPV modified paclitaxel and schisandrin B liposomes ，the survival rate ，migration inhibition rate and invasion rate of SK-OV- 3 cells were significantly decreased （P＜0.05）. The effects of RPV modified paclitaxel and schisandrin B liposomes was better than those of paclitaxel and schisandrin B liposomes （P＜0.05）. CONCLUSIONS ：RPV modified paclitaxel and schisandra B liposome are successfu lly prepared ，and they have certain antitumor activity in vitro .

OBJECTIVE: To evaluate rectal toxicity of radiotherapy for prostate cancer using a novel predictive model based on multi-modality and multi-classifier fusion. METHODS: We retrospectively collected the clinical data from 44 prostate cancer patients receiving external beam radiation (EBRT), including the treatment data, clinical parameters, planning CT data and the treatment plans. The clinical parameter features and dosimetric features were extracted as two different modality features, and a subset of features was selected to train the 5 base classifiers (SVM, Decision Tree, K-nearest-neighbor, Random forests and XGBoost). To establish the multi-modality and multi-classifier fusion model, a multi-criteria decision-making based weight assignment algorithm was used to assign weights for each base classifier under the same modality. A repeat 5-fold cross-validation and the 4 indexes including the area under ROC curve (AUC), accuracy, sensitivity and specificity were used to evaluate the proposed model. In addition, the proposed model was compared quantitatively with different feature selection methods, different weight allocation algorithms, the model based on single mode single classifier, and two integrated models using other fusion methods. RESULTS: Repeated (5 times) 5-fold cross validation of the proposed model showed an accuracy of 0.78 for distinguishing toxicity from non-toxicity with an AUC of 0.83, a specificity of 0.79 and a sensitivity of 0.76. CONCLUSIONS Compared with the models based on a single mode or a single classifier and other fusion models, the proposed model can more accurately predict rectal toxicity of radiotherapy for prostate cancer.
Algorithms ; Area Under Curve ; Humans ; Male ; Prostatic Neoplasms ; Rectum ; Retrospective Studies