Objective:To investigate the change trend of hepatectomy for hepatocellular carcinoma and efficacy of fluorescent laparoscopic hepatectomy in a single center from 2014?2023.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 17 232 patients of hepatocellular carcinoma who were admitted to Zhongshan Hospital of Fudan University from January 2014 to December 2023 were collected. There were 14 404 males and 2 828 females, aged 58(range, 11?94)years. Observation indicators: (1) change trend of hepatectomy for hepatocellular carcinoma and application of fluorescent laparoscopy in 2014?2023; (2) propensity score matching between patients undergoing fluorescent and conventional laparoscopic hepatectomy; (3) intraoperative and postoperative conditions of patients in the fluorescent laparoscopy group and the conventional laparoscopy group after propensity score matching. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the nonparametic rank sum test. Propensity score matching was performed using the 1∶3 nearest neighbor matching method, with the caliper value of 0.01. Results:(1) Change trend of hepatectomy for hepatocellular carcinoma and application of fluorescent laparoscopy in 2014-2023. Among 17 232 patients of hepatocellular carcinoma, 4 074 cases underwent laparoscopic surgery, and 13 158 cases underwent open surgery or conversion from laparoscopic to open surgery. From 2014 to 2023, the proportions of laparos-copic surgery in hepatectomy were 8.993%(117/1 301), 6.804%(99/1 455), 9.379%(145/1 546), 17.511%(287/1 639), 23.828%(427/1 792), 24.572%(459/1 868), 29.662%(544/1 834), 31.568%(584/1 850), 38.080%(599/1 573), and 34.246%(813/2 374), respectively. The proportions of Grade Ⅲ surgery in laparoscopic hepatectomy were 11.966%(14/117), 7.071%(7/99), 12.414%(18/145), 21.254%(61/287), 28.337%(121/427), 27.887%(128/459), 34.375%(187/544), 34.644%(214/584), 35.726%(214/599), and 42.681%(347/813), respectively. From 2016 to 2023, the proportions of the application of fluorescent laparoscopy in laparoscopic hepatectomy were 2.069%(3/145), 5.923%(17/287), 8.431%(36/427), 10.022%(46/459), 17.647%(96/544), 24.829%(145/584), 9.182%(55/599), and 12.915%(105/813), respectively. (2) Propensity score matching between patients undergoing fluorescent and conventional laparoscopic hepatectomy. Among the 4 074 patients who underwent laparoscopic liver resection, 503 cases using fluorescent laparoscopy were assigned to the fluorescent laparoscopy group, 3 571 cases using conventional laparoscopy were assigned to the conventional laparoscopy group. A total of 1 794 patients were successfully matched, with 483 cases in the fluorescent laparoscopy group and 1 311 cases in the conventional laparoscopy group. After propensity score matching, the confounding biases of the maximum tumor diameter and the year of surgery were eliminated, and the two groups were comparable. (3) Intraoperative and postoperative conditions of patients in the fluorescent laparoscopy group and the conventional laparoscopy group after propensity score matching. After propensity score matching, there was no perioperative death in either the fluorescent laparoscopy group or the conventional laparoscopy group.The operation time of patients in the fluorescent laparoscopy group was 240(150,328)minutes, the portal triad clamping time was 30(15,45)minutes, the volume of intraoperative blood loss was 50(30,100)mL, the number of patients with complication 72, respectively. For patients in the conventional laparoscopy group, the above indicators were 180(131,240)minutes, 23(15,30)minutes, 55(50,100)mL, and 248, respectively. There were significant differences in the above indicators between the two groups ( Z=?7.593, ?7.372, ?4.941, χ2=3.873, P<0.05). Conclusion:The proportion and difficulty level of laparoscopic hepatectomy for hepatocellular carcinoma in Zhongshan Hospital of Fudan University have shown an upward trend during 2014?2023. Compared with conventional laparoscopy, patients undergoing fluorescent laparoscopic hepatectomy have longer operation time and portal triad clamping time, but less intraoperative blood loss and lower iproportion of complications.

International studies have established that electrons, X-rays, protons, and heavy ions can all be utilized in ultra-high dose-rate radiotherapy. Among these modalities, megavoltage X-ray ultra-high dose-rate radiotherapy holds particularly broad clinical promise. With its long-term expertise in high-intensity pulsed radiation sources, the Institute of Applied Electronics at the China Academy of Engineering Physics has pioneered global solutions for generating and measuring megavoltage X-rays ultra-high dose-rate radiotherapy, positioning China at the forefront of this field. Herein, we review the development history, current status, and future trends in ultra-high dose-rate X-ray generation, measurement, and protection. The insights provided aim to serve as a reliable reference for clinical and preclinical research, equipment development, and standardization, thereby enabling more precise and reliable megavoltage ultra-high dose-rate X-ray production and measurement. We hope this work will significantly support further research and clinical translation of ultra-high dose-rate radiotherapy technology.

Objective:To establish a rapid and precise dose measurement method with EBT4 film and ensure its measurement accuracy to be within the required range through strict operational procedures for the purpose of addressing the two essential issues of poor measurement accuracy and timeliness of EBT film under FLASH conditions.Methods:After storing under different humidity conditions for a certain period of time, the film was exposed to radiation for analyzing the influence of air humidity on the intrinsic performance of EBT film. By means of repeated scanning operations and the film angle rotation, the influences of repeated scanning and film placement angle were analuzed. Parabolic correction method was used to reduce the spatial position influence during the scanning process. By analying the relationship between net optical density (netOD) and absorbed dose through the comparison of three fitting method, the optimal fitting curve was selected. After irradiation of the same batch of films for 5 min and 24 h, the film doses were calibrated and then compared with ionization chamber-measured result. The rapid and precise film dosimetry method was used to measure both the percentage depth dose from X-rays at ultra-high dose rate and the dose distribution at a depth of 2 cm in water.Results:Air humidity had the greatest influence on the intrinsic performance of EBT film (approximately 20%). The average deviation of repeated scans is within 0.5%. The angle at which the film is placed significantly affected the readouts of the film with the maximum influence approximately 70%. The net optical density combined with polynomial fitting can control the fitting residuals of 1-16 Gy within 3%. The change rate of light channels at 5 min already mostly met the requirements of the rapid mode (< 0.5%). Compared with the measurement result obtained using the reference ionization chamber, the deviations of the 5 min or 24 h dose calibration curves were all within 2%.Conclusions:The EBT4 film can be employed as a precise dosimeter to quickly measure the FLASH radiation dose. Rapid and precise FLASH dose measurements can meet the stringent requirements of both preclinical and clinical FLASH research.

Objective:To design two kinds of intensity modulated radiotherapy (IMRT) plans with different radiation field distributions,and to compare the dose differences of that at the dose of target region and organs at risk (OAR) for middle and lower esophageal cancer,so as to provide a reference for the design of IMRT plan. Methods:The data of 17 patients with middle and lower esophageal cancer who received IMRT at Shangluo Central Hospital from November 2022 to May 2023 were retrospectively analyzed. IMRT plans with different radiation fields for Plan 1 and Plan 2 were designed for each patient. The angles of radiation field for Plan 1 were 0°,80°,120°,160° and 200°,and those for Plan 2 were 30°,130°,180°,230° and 330°,respectively. The prescribed dose to the planning target volume (PTV) was 60 Gy/30 F. The differences in dosimetric parameters between the two plans were compared. Results:There were no statistically significant differences in the dose parameters of 2％,98％,50％ target dose (D2％,D98％,D50％),homogeneity index (HI),conformity index (CI) and monitor unit between the two groups (P>0.05). There were no significant differences in V5 of dual lungs,the mean dose (Dmean) of heart,and the maximum dose (Dmax) of spinal-cord between two groups (P>0.05). The volume percentage (V10,V20,V30) of dual lungs received radiation doses of 10,20 and 30 Gy,and the mean dose (Vmean) of lung in the Plan1 group reduced respectively 7.44％,21.16％,10.09％ and 5.31％ than those in the Plan2 group,and the differences of them were statistically significant (t=-5.845,-7.729,-2.247,-3.960,P<0.05). Heart V10 and V20 in the Plan1 group decreased respectively by 7.23％ and 5.78％,with statistical significance (t=-4.376,-3.523,P<0.01),while V30 and V40 of Plan 1 increased respectively by 2.7％ and 4.92％,without statistical significance (P>0.05). There was no significant difference in heart Dmean between the Plan1 group and the Plan2 group (P>0.05). Conclusion:Both two methods of distribution field can meet the clinical requirements,and Plan1 has more advantages in protecting organs at risk under the premise of meeting the requirements of target region.

Objective:To design two kinds of intensity modulated radiotherapy (IMRT) plans with different radiation field distributions,and to compare the dose differences of that at the dose of target region and organs at risk (OAR) for middle and lower esophageal cancer,so as to provide a reference for the design of IMRT plan. Methods:The data of 17 patients with middle and lower esophageal cancer who received IMRT at Shangluo Central Hospital from November 2022 to May 2023 were retrospectively analyzed. IMRT plans with different radiation fields for Plan 1 and Plan 2 were designed for each patient. The angles of radiation field for Plan 1 were 0°,80°,120°,160° and 200°,and those for Plan 2 were 30°,130°,180°,230° and 330°,respectively. The prescribed dose to the planning target volume (PTV) was 60 Gy/30 F. The differences in dosimetric parameters between the two plans were compared. Results:There were no statistically significant differences in the dose parameters of 2％,98％,50％ target dose (D2％,D98％,D50％),homogeneity index (HI),conformity index (CI) and monitor unit between the two groups (P>0.05). There were no significant differences in V5 of dual lungs,the mean dose (Dmean) of heart,and the maximum dose (Dmax) of spinal-cord between two groups (P>0.05). The volume percentage (V10,V20,V30) of dual lungs received radiation doses of 10,20 and 30 Gy,and the mean dose (Vmean) of lung in the Plan1 group reduced respectively 7.44％,21.16％,10.09％ and 5.31％ than those in the Plan2 group,and the differences of them were statistically significant (t=-5.845,-7.729,-2.247,-3.960,P<0.05). Heart V10 and V20 in the Plan1 group decreased respectively by 7.23％ and 5.78％,with statistical significance (t=-4.376,-3.523,P<0.01),while V30 and V40 of Plan 1 increased respectively by 2.7％ and 4.92％,without statistical significance (P>0.05). There was no significant difference in heart Dmean between the Plan1 group and the Plan2 group (P>0.05). Conclusion:Both two methods of distribution field can meet the clinical requirements,and Plan1 has more advantages in protecting organs at risk under the premise of meeting the requirements of target region.

Objective:To study the resistance of Aedes albopictus to commonly used insecticides in Hangzhou, and to investigate the polymorphism distribution characteristics of voltage-gated sodium channel (VGSC) and acetylcholinesterase (AchE) 1 (Ace-1) genes in Aedes albopictus in the region, providing a scientific basis for control of Aedes albopictus in Hangzhou. Methods:From May to June 2023, Aedes albopictus larvae and pupae were collected from residential areas across divided different urban areas by directions in Hangzhou. They were reared in the laboratory, and their resistance to malathion, propoxur, pyrethroid insecticides (permethrin, deltamethrin, and beta-cypermethrin) was evaluated using the World Health Organization-recommended adult mosquito contact tube method. The 24 h mortality rates of adult mosquito of 98% - 100% was susceptible, 80% - < 98% was suspected resistance, < 80% was resistant. Genomic DNA was extracted from adult Aedes albopictus, and mutations in the VGSC and Ace-1 genes were detected through PCR amplification and Sanger sequencing. Results:The 24 h mortality rates of adult Aedes albopictus exposed to 0.5% malathion, 0.05% propoxur, 0.4% permethrin, 0.03% deltamethrin, and 0.08% beta-cypermethrin in Hangzhou were 100% (75/75), 96.00% (72/75), 41.43% (29/70), 17.33% (13/75), and 32.86% (23/70), respectively. A total of 146 surviving Aedes albopictus were tested for VGSC gene mutations at diagnostic doses of pyrethroid insecticides. Among them, 6 Aedes albopictus (4.11%) had a gene mutation at position V1016, and 146 Aedes albopictus (100%) had a gene mutation at position F1534. A total of 63 Aedes albopictus that died at diagnostic doses of pyrethroid insecticides were analyzed for VGSC gene mutations. No gene mutation was detected at position V1016, while 63 Aedes albopictus (100%) had a gene mutation at position F1534. One non synonymous mutation was detected at position V1016 of the VGSC gene, which was a heterozygous mutation of V1016V to V1016V/G. Two non synonymous mutations were detected at position F1534 of the VGSC gene, namely F1534F to F1534S or a F1534F/S heterozygous mutation. No Ace-1 gene mutation was detected in all Aedes albopictus exposed to 0.05% propoxur ( n = 75). Conclusions:The Aedes albopictus in Hangzhou has developed resistance to permethrin, deltamethrin, and beta-cypermethrin. It shows suspected resistance to propoxur and sensitivity to malathion. Moreover, a high frequency of mutations in the VGSC gene has been observed in these mosquitoes. It is crucial to enhance resistance monitoring in Aedes albopictus populations in Hangzhou and to implement the rational rotation of chemical insecticides to slow down the progress of drug resistance.

Standardized training of newly recruited nurses is crucial for enhancing their clinical competencies and facilita-ting rapid adaptation to clinical environments.This approach aims to develop nursing professionals with advanced clinical skills and expertise.This paper reviews and analyzes the training paradigms for new nurses globally,focusing on the challenges faced in the standardized training of new nurses in China,to provide insights and references for future training programs.

Objective To evaluate the effectiveness of WeChat group integrating with BOPPPS instructional model in the standardized training of nurses in an orthopedics department.Methods A total of 56 nurses in orthopedical standardized training from a hospital were selected and divided into a control group(28 nurses from September 2022 to August 2023)and an interven-tion group(28 nurses trained via WeChat groups and the BOPPPS model from September 2023 to August 2024).The two groups were compared in terms of their final assessment scores,critical thinking,and self-directed learning capabilities.Results After training,the intervention group had significantly higher scores in the final assessment,all items of the California Critical Thinking Disposition Inventory,and all dimensions of the Learning Ability Assessment Scale compared to the control group(all P＜0.05).Conclusion WeChat groups combined with the BOPPPS teaching mode effectively improves the self-directed learning ability,critical thinking skills,and assessment results of orthopedic nurses.

Aptamers are a class of short DNA/RNA single strand oligonucleotides that can bind to target molecules with high affinity specificity. They have the advantages of high affinity specificity, low molecular weight and low immunogenicity, and have been widely used in biomedical research, clinical diagnosis and therapy, and biosensor development. Systematic evolution of ligand by exponential enrichment (SELEX) is an in vitro screening technique, which enriches the aptamers with high affinity and specific binding to the target through multiple cycles of screening, and has a wide range of applications in tumor therapy.

International studies have established that electrons, X-rays, protons, and heavy ions can all be utilized in ultra-high dose-rate radiotherapy. Among these modalities, megavoltage X-ray ultra-high dose-rate radiotherapy holds particularly broad clinical promise. With its long-term expertise in high-intensity pulsed radiation sources, the Institute of Applied Electronics at the China Academy of Engineering Physics has pioneered global solutions for generating and measuring megavoltage X-rays ultra-high dose-rate radiotherapy, positioning China at the forefront of this field. Herein, we review the development history, current status, and future trends in ultra-high dose-rate X-ray generation, measurement, and protection. The insights provided aim to serve as a reliable reference for clinical and preclinical research, equipment development, and standardization, thereby enabling more precise and reliable megavoltage ultra-high dose-rate X-ray production and measurement. We hope this work will significantly support further research and clinical translation of ultra-high dose-rate radiotherapy technology.