OBJECTIVE: To analyze the time characteristics of the Ethos online adaptive radiotherapy (OART) process in clinical practice and provide guidance for the comprehensive optimization of each stage of adaptive radiotherapy. METHODS: The study involved 61 patients with cervical, rectal, gastric, lung, esophageal, and breast cancers who underwent Ethos OART. The mean ± standard deviation of segmental time, total time, and target volume for these patients were tracked. The time characteristics for different cancer types were evaluated, and the average time for target and organ at risk (OAR) modifications was compared with the average target volume for each cancer type. RESULTS: Cervical cancer born the longest total treatment time, while breast cancer had the shortest. For all cancer types except breast cancer, the modification time for target and OAR was the most time-consuming segment. The average time for target and OAR modifications aligned with the trend of the average target volume. CONCLUSION The total treatment time for various cancers ranges from 15 to 35 minutes, indicating room for improvement.
Humans ; Radiotherapy Planning, Computer-Assisted/methods* ; Neoplasms/radiotherapy* ; Female

Objective To re-evaluate systematic reviews on the application of virtual reality(VR)technology in limb rehabilitation for stroke patients,providing evidence to support the implementation of VR.Methods Systematic searches were conducted in Web of Science,PubMed,CINAHL,Cochrane Library,Embase,CNKI,CBM,WanFang,and VIP databases from their inception until March 2025,identifying systematic reviews/meta-analyses investigating VR for limb rehabilitation in stroke patients.2 researchers independently screened the literature.Methodological quality was evaluated using the Assessment of Mutiple System Reviews 2(AMSTAR 2)tool;reporting quality was evaluated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines;evidence quality was graded using the Grades of Recommendations Assessment,Development,and Evaluation(GRADE)system;literature overlap was assessed using the Corrected Covered Area(CCA)method.Results A total of 15 articles were included.According to AMSTAR 2,totally 3 reviews were of moderate quality,while the remainder were rated as low or very low quality.PRISMA scores ranged from 19.5 to 27.0 points.Based on GRADE,a review was classified as high quality,6 as moderate quality,and the remainder as low or very low quality.The CCA was 5.3％,indicating slight overlap.Conclusion VR contributes to the improvement of indicators such as upper limb motor function/mobility and lower limb balance in stroke patients.However,methodological limitations,including weak control of bias and inadequate handling of heterogeneity among included studies,restrict the overall quality of evidence.Further standardized,high-quality studies are needed to provide more reliable evidence to support clinical decision-making.

Objective To re-evaluate systematic reviews on the application of virtual reality(VR)technology in limb rehabilitation for stroke patients,providing evidence to support the implementation of VR.Methods Systematic searches were conducted in Web of Science,PubMed,CINAHL,Cochrane Library,Embase,CNKI,CBM,WanFang,and VIP databases from their inception until March 2025,identifying systematic reviews/meta-analyses investigating VR for limb rehabilitation in stroke patients.2 researchers independently screened the literature.Methodological quality was evaluated using the Assessment of Mutiple System Reviews 2(AMSTAR 2)tool;reporting quality was evaluated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines;evidence quality was graded using the Grades of Recommendations Assessment,Development,and Evaluation(GRADE)system;literature overlap was assessed using the Corrected Covered Area(CCA)method.Results A total of 15 articles were included.According to AMSTAR 2,totally 3 reviews were of moderate quality,while the remainder were rated as low or very low quality.PRISMA scores ranged from 19.5 to 27.0 points.Based on GRADE,a review was classified as high quality,6 as moderate quality,and the remainder as low or very low quality.The CCA was 5.3％,indicating slight overlap.Conclusion VR contributes to the improvement of indicators such as upper limb motor function/mobility and lower limb balance in stroke patients.However,methodological limitations,including weak control of bias and inadequate handling of heterogeneity among included studies,restrict the overall quality of evidence.Further standardized,high-quality studies are needed to provide more reliable evidence to support clinical decision-making.

Objective:To investigate the clinical effect of composite surgery in the treatment of chronic common carotid artery occlusion(CCAO).Methods:A retrospective descriptive study was conducted. The clinical data of 7 patients with CCAO admitted to Xuanwu Hospital, Capital Medical University from October 2020 to December 2023 were collected retrospectively. There were 6 males and 1 female. The age was (66.7±10.9) years, ranging from 52 to 83 years. Outpatient or telephone follow-up were conducted after surgery, carotid artery ultrasound or computed tomography angiography were performed at 3 months, 6 months, and 1 year postoperatively to determine vascular patency. The selection of surgical methods and clinical effect were analyzed. Normally distributed measurement data were expressed as mean±standard deviation ( ± s). The measurement data of skewed distribution were expressed by M ( Q1, Q3). Count data were expressed as frequency. Results:All 7 patients were diagnosed with chronic CCAO before operation, 6 on the left and 1 on the right. 3 cases affected the middle and distal segments of the common carotid artery, 1 case affected the proximal segment, and 1 case each affected the middle and distal segments, the remaining case involves the entire common carotid artery. All the procedures were successfully performed, among which 4 cases underwent carotid endarterectomy combined with stent placement, and 3 cases did not receive stent placement after carotid endarterectomy. 1 patient developed neck hematoma after surgery and the remaining patients recovered well after surgery without any complications or deaths. The follow-up time was 13.5(4.0, 20.5) months; 1 patient was lost to follow-up, and 6 patients received effective follow-up. the common carotid artery remained unobstructed in all 6 patients, and there were no transient ischemic attacks or strokes during the follow-up period.Conclusion:Composite surgery is a safe and feasible method that can be used to treat chronic CCAO lesions, and has satisfactory short-term results.

Objective To construct a risk prediction model for ventilator-associated pneumonia(VAP)in trauma patients and evaluate its efficacy.Methods A single-center retrospective study was conducted,trauma patients admitted to the department of emergency intensive care unit(EICU)of Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine from January 1,2018 to January 1,2023 were selected as the study subjects,and the patients were divided into VAP group and non-VAP group.Differences between the two groups in variables including demographic characteristics,clinical data,and clinical scores.To prevent overfitting,differences between the groups were reduced using LASSO regression.Multifactor Logistic regression was used to identify risk factors for VAP in trauma patients and construct a risk prediction model.The model's discrimination was evaluated using the receiver operator characteristic curve(ROC curve)and area under the curve(AUC).The calibration curve was drawn and Hosmer-Lemeshow test were performed to evaluate the calibration degree of the model.Decision curve analysis(DCA)and clinical impact curve(CIC)were used to analyse the model's net benefit at different probability thresholds.Results A total of 888 trauma patients were included,among which 166 cases(18.7%)were diagnosed with VAP.Compared to the non-VAP group,the VAP group showed a significant increase in age,age-adjusted Charlson comorbidity index(aCCI)scores,white blood cell count(WBC),sequential organ failure assessment(SOFA)scores,length of ICU stay,and the proportion of patients with chest trauma,traumatic brain injury,and spinal cord injury.In contrast,hemoglobin(Hb),Glasgow coma scale(GCS)scores,and body mass index(BMI)were significantly lower in the VAP group(all P<0.05).Using LASSO regression,four variables were identified as important predictors for the occurrence of VAP in trauma patients:length of ICU stay,aCCI,WBC,and SOFA score.Multivariate Logistic regression showed that length of ICU stay[odds ratio(OR)and 95%confidence interval(95%CI)was 1.094(1.070-1.117)],aCCI[OR(95%CI)was 1.135(1.065-1.210)],WBC[OR(95%CI)was 1.139(1.104-1.176)],and SOFA score[OR(95%CI)was 1.137(1.080-1.197)]were independent risk factors for the occurrence of VAP in trauma patients(all P<0.05).Based on these influencing factors,a predictive model for VAP occurrence was constructed.ROC curve analysis showed that the AUC for predicting VAP occurrence in trauma patients was 0.876,with a 95%CI was 0.850-0.903,a sensitivity of 86.14%,and a specificity of 75.17%,indicating that the model has a high discriminative ability.Hosmer-Lemeshow test:χ2=7.7,P=0.2,Cox&Snell R2=0.236,Nagelkerke R2=0.387,the calibration curve was very close to the diagonal,and the mean absolute error(MAE)=0.03,indicating the model's predictions were highly consistent with actual clinical observations.The DCA and CIC curves indicate that within the threshold probability of<70%,using this model to identify high-risk groups for VAP in trauma patients and making clinical decisions can provide benefits in clinical practice.Conclusion The risk prediction model of VAP in trauma patients constructed in this study has high discrimination and calibration,which can provide reference for medical personnel to identify high-risk groups of VAP among trauma patients at an early stage and provide targeted intervention measures.

AIM:To investigate the role of phosphoenolpyruvate carboxykinase 1(PCK1)in the proliferation and migration of mouse vascular smooth muscle cells(VSMCs)and the underlying mechanism.METHODS:The prolif-eration and migration of mouse VSMCs were induced by platelet-derived growth factor(PDGF)-BB.The cells were divided into a vehicle group and a PDGF-BB group.The expression of PCK1 was detected by Western blot and immunofluores-cence staining.The mouse Pck1 siRNA(si Pck1)were transfected into mouse VSMCs to silence PCK1.The cells were di-vided into the vehicle,si Pck1+vehicle,PDGF-BB and si Pck1+PDGF-BB groups.The protein level of PCK1 was detected by Western blot.The proliferation was explored by Ki-67 immunofluorescence staining and the viability was detected by CCK-8 assay.The migration was determined by a scratch test.Mitochondrial dynamics were observed via transmission electron microscopy.A lentivirus carrying dynamin-related protein 1(Drp1)gene(lenti-Drp1)was transfected into VSMCs to induce them to overexpress DRP1.The cells were divided into the PDGF-BB,si Pck1+PDGF-BB,lenti-Drp1+PDGF-BB and lenti-Drp1+si Pck1+PDGF-BB groups.Proliferation,migration and mitochondrial dynamics were measured as described above.RESULTS:PDGF-BB increased the protein expression of PCK1 and DRP1,cell viability,the per-centage of Ki-67-positive cells,the wound healing rate and mitochondrial division in VSMCs.These effects were sup-pressed when PCK1 protein expression was silenced.After DRP1 was overexpressed,the inhibitory effects of PCK1 silenc-ing on cell viability,the percentage of Ki-67-positive cells,the wound healing rate and mitochondrial division were signifi-cantly reversed.CONCLUSION:PCK1 promotes the mitochondrial division,proliferation and migration of VSMCs in mice by upregulating the expression of DRP1.

Objective To construct a risk prediction model for ventilator-associated pneumonia(VAP)in trauma patients and evaluate its efficacy.Methods A single-center retrospective study was conducted,trauma patients admitted to the department of emergency intensive care unit(EICU)of Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine from January 1,2018 to January 1,2023 were selected as the study subjects,and the patients were divided into VAP group and non-VAP group.Differences between the two groups in variables including demographic characteristics,clinical data,and clinical scores.To prevent overfitting,differences between the groups were reduced using LASSO regression.Multifactor Logistic regression was used to identify risk factors for VAP in trauma patients and construct a risk prediction model.The model's discrimination was evaluated using the receiver operator characteristic curve(ROC curve)and area under the curve(AUC).The calibration curve was drawn and Hosmer-Lemeshow test were performed to evaluate the calibration degree of the model.Decision curve analysis(DCA)and clinical impact curve(CIC)were used to analyse the model's net benefit at different probability thresholds.Results A total of 888 trauma patients were included,among which 166 cases(18.7%)were diagnosed with VAP.Compared to the non-VAP group,the VAP group showed a significant increase in age,age-adjusted Charlson comorbidity index(aCCI)scores,white blood cell count(WBC),sequential organ failure assessment(SOFA)scores,length of ICU stay,and the proportion of patients with chest trauma,traumatic brain injury,and spinal cord injury.In contrast,hemoglobin(Hb),Glasgow coma scale(GCS)scores,and body mass index(BMI)were significantly lower in the VAP group(all P<0.05).Using LASSO regression,four variables were identified as important predictors for the occurrence of VAP in trauma patients:length of ICU stay,aCCI,WBC,and SOFA score.Multivariate Logistic regression showed that length of ICU stay[odds ratio(OR)and 95%confidence interval(95%CI)was 1.094(1.070-1.117)],aCCI[OR(95%CI)was 1.135(1.065-1.210)],WBC[OR(95%CI)was 1.139(1.104-1.176)],and SOFA score[OR(95%CI)was 1.137(1.080-1.197)]were independent risk factors for the occurrence of VAP in trauma patients(all P<0.05).Based on these influencing factors,a predictive model for VAP occurrence was constructed.ROC curve analysis showed that the AUC for predicting VAP occurrence in trauma patients was 0.876,with a 95%CI was 0.850-0.903,a sensitivity of 86.14%,and a specificity of 75.17%,indicating that the model has a high discriminative ability.Hosmer-Lemeshow test:χ2=7.7,P=0.2,Cox&Snell R2=0.236,Nagelkerke R2=0.387,the calibration curve was very close to the diagonal,and the mean absolute error(MAE)=0.03,indicating the model's predictions were highly consistent with actual clinical observations.The DCA and CIC curves indicate that within the threshold probability of<70%,using this model to identify high-risk groups for VAP in trauma patients and making clinical decisions can provide benefits in clinical practice.Conclusion The risk prediction model of VAP in trauma patients constructed in this study has high discrimination and calibration,which can provide reference for medical personnel to identify high-risk groups of VAP among trauma patients at an early stage and provide targeted intervention measures.

Diabetic foot ulcer is a serious and destructive complication of diabetes， with the rates of disability and mortality increasing year by year， which poses a serious threat to human physical and mental health. In the treatment of diabetic foot ulcer with traditional Chinese medicine （TCM）， the combination of syndrome differentiation and overall concept can not only alleviate TCM syndrome but also accelerate wound healing， reduce wound recurrence， delay the further deterioration of diabetic foot ulcer， and decrease the rates of disability and mortality. Modern studies have demonstrated that the difficult healing of diabetic foot ulcer is closely associated with the abnormal distribution of cytokines such as inflammatory cytokines， growth factors， and chemokines. With the deepening of modern medical research on TCM， the treatment of diabetic foot ulcer via regulation of cytokines by Chinese medicinal monomers and prescriptions has become a research focus. This paper summarizes the current research status at home and abroad and draws the following conclusions. ① Sesamol， geniposide， Danggui Buxuetang， and Zizhu ointment can regulate tumor necrosis factor-α （TNF-α）， interleukin （IL）-1， IL-6， IL-10 and other inflammatory cytokines to inhibit wound inflammation. ② Angelicae Dahuricae Radix， salvianolic acid B， Sixiao powder， Badu Shengji ointment （Zhuang medicine）， etc.， regulate vascular endothelial growth factor （VEGF）， platelet-derived growth factor （PDGF）， transforming growth factor （TGF）， epidermal growth factor （EGF） and other growth factors to promote collagen deposition and angiogenesis on wound surface. ③ Paeoniflorin， cryptanshinone， bee venom， and Huiyang Shengji decoction regulate CXC chemokine ligand （CXCL） 1， CXCL2， C-C chemokine ligand （CCL） 2， CCL3， stromal cell-derived factor-1α （SDF-1α）， monocyte chemoattract protein-1 （MCP-1） and other chemokines to reduce inflammatory response and promote neovascularization and wound granulation tissue formation. ④ In the treatment of diabetic foot ulcer， Chinese medicinal monomers and prescriptions have different and complicated mechanisms. The multi-target treatment manner determines that Chinese medicines can act on a variety of cytokines to participate in various stages of wound healing and thus play a therapeutic role. The conclusion above aims to provide ideas for the experimental research and clinical treatment of diabetic foot ulcer with TCM in the future.

Objective:To evaluate the dosimetric characteristics of Zap-X system and CyberKnife (CK) G4 system of stereotactic radiosurgery (SRS) for single brain metastasis.Methods:Twelve patients with single brain metastasis had been treated with CK were selected retrospectively. The prescribed dose of planning target volume (PTV) was 18-24 Gy for 1-3 fractions. The PTV was ranged from 0.44 to 11.52 cm 3. The 12 patients were re-planned in the Zap-X planning system using the same prescription dose and organs at risk constraints, and the prescription dose of PTV was normalized to 70% for both Zap-X and CK. The planning parameters and dosimetric parameters of PTV and organs at risk were compared and evaluated between two plans. All data were read at MIM Maestro. A paired Wilcoxon' signed-rank test was adopted for statistical analysis. A P value of less than 0.05 was considered as statistical significance. Results:For the target coverage, CK was significantly higher than Zap-X (99.14±0.57% vs. 97.55±1.34%, P<0.01), but Zap-X showed a higher conformity index (0.81±0.05 vs. 0.77±0.07, P<0.05), a lower Paddick gradient index (2.98±0.24 vs. 3.15±0.38), and a higher gradient score index (GSI) than CK. The total monitor unit (MU) of Zap-X was significantly lower than that of CK (11 627.63 ±5 039.53 vs. 23 522.16 ±4 542.12, P<0.01) and the treatment time was shorter than that of CK [(25.08 ±6.52) vs. (38.08 ±4.74) min, P<0.01]. Zap-X had lower dose volumes than CK for the dose of brain ( P<0.05). Zap-X had a lower D mean and D max of brainstem (both P<0.05), but a higher value of eyes and lens. For optic nerves and optic chiasm, there were no significant differences between two groups. In addition, for the protection of skin (V 22.5 Gy), Zap-X seemed better than CK [(4.15±4.48) vs. (4.37±4.50) cm 3, P<0.05]. Conclusions:For SRS treating single brain metastasis, Zap-X could provide a high quality plan equivalent to or even better than CK, especially reducing the treatment time. With continuous improvement and upgrading of Zap-X system, it may become a new SRS platform for the treatment of brain metastasis.

Objective:To compare the dosimetric characteristics of beams between Zap-X and G4 CyberKnife and provide reference for clinical application of Zap-X.Methods:PTW three-dimensional water tank and dosimetry diode ionization chamber were used to measure the two orthogonal off-axis ratio and field size at isocenter of 7 different collimators (5 mm, 7.5 mm, 10 mm, 12.5 mm, 15 mm, 20 mm and 25 mm) of Zap-X and CyberKnife at the water depth of maximum dose, 50 mm, 100 mm, and 200 mm. The penumbra, flatness, symmetry and field size under each parameter condition were analyzed by using PTW supporting software PTW MEPHYSTO (version 5.1). Data analysis and graph were performed using Origin 2021 software.Results:With the same collimator, the dose plateau area of Zap-X was wider than that of G4 CyberKnife, and the dose fall-off at the field edge of Zap-X system was faster. With the increase of the collimator, the penumbra of Zap-X and CyberKnife tended to become larger, and the flatness tended to become smaller, the penumbra and flatness of Zap-X were significantly smaller than those of CyberKnife. Both of them had excellent symmetry (<1%), and the symmetry results of CyberKnife (<0.39%) were better than that of Zap-X (0.99%). The accuracy of Zap-X collimator size at isocenter was better than that of CyberKnife.Conclusion:Compared with G4 CyberKnife, Zap-X system has smaller penumbra, better flatness and higher accuracy of collimator size, which is suitable for stereotactic radiosurgery.