Background: Twenty-four-hour urinary free cortisol (UFC) measurement is the initial diagnostic test for Cushing’s syndrome (CS). We compared UFC determination by both direct and extraction immunoassays using Abbott Architect, Siemens Atellica Solution, and Beckman DxI800 with liquid chromatography-tandem mass spectrometry (LC-MS/MS). In addition, we evaluated the value of 24-hr UFC measured by six methods for diagnosing CS. Methods: Residual 24-hr urine samples of 94 CS and 246 non-CS patients were collected.A laboratory-developed LC-MS/MS method was used as reference. UFC was measured by direct assays (D) using Abbott, Siemens, and Beckman platforms and by extraction assays (E) using Siemens and Beckman platforms. Method was compared using Passing–Bablok regression and Bland–Altman plot analyses. Cut-off values for the six assays and corresponding sensitivities and specificities were calculated by ROC analysis. Results: Abbott-D, Beckman-E, Siemens-E, and Siemens-D showed strong correlations with LC-MS/MS (Spearman coefficient r = 0.965, 0.922, 0.922, and 0.897, respectively), while Beckman-D showed weaker correlation (r = 0.755). All immunoassays showed proportionally positive bias. The areas under the curve were 0.975 for Abbott-D, 0.972 for LCMS/MS, 0.966 for Siemens-E, 0.948 for Siemens-D, 0.955 for Beckman-E, and 0.877 for Beckman-D. The cut-off values varied significantly (154.8–1,321.5 nmol/24 hrs). Assay sensitivity and specificity ranged from 76.1% to 93.2% and from 93.0% to 97.1%, respectively. Conclusions Commercially available immunoassays for measuring UFC show different levels of analytical consistency compared to LC-MS/MS. Abbott-D, Siemens-E, and Beckman-E have high diagnostic accuracy for CS.

Objective:To understand the trend in the disease burden of tuberculosis in the BRICS countries (Brazil, Russia, India, China, and South Africa) from 1990 to 2019, forecast the incidence of tuberculosis in the BRICS countries from 2020 to 2030.Methods:This study used data from the Global Burden of Disease Study 2019 to describe the incidence trends from 1990 to 2019 and epidemiological characteristics of tuberculosis in the BRICS countries. The Bayesian-age- period-cohort model was used to predict the incidence of tuberculosis in the BRICS countries from 2020 to 2030.Results:Although the age-standardized incidence rates (ASIR) of tuberculosis were on the decline in all BRICS countries, the magnitude of the decline varied, with the most significant decline in China and the least in South Africa. In 2019, there were gender and age differences in the incidence of tuberculosis in all BRICS countries. Except for South Africa, the ASIR in males were higher than that in females and except for South Africa and Russia, the incidence rates of tuberculosis showed an increasing trend with age in all BRICS countries. From 2020 to 2030, the incidence rates of tuberculosis in the BRICS countries were projected to be declining, except it was likely to increase among women in Russia. However, the expected decrease of tuberculosis incidence in the BRICS countries by 2030 would be less than 80% as compared to that of 2015.Conclusions:Positive results have been achieved in the prevention and treatment of tuberculosis in BRICS countries. But the situation is still serious, with demographic differences in the incidence of tuberculosis in different countries.

Objective To investigate the value of CT radiomics models based on intranodal and perinodal in distinguishing pulmonary cryptococcosis(PC)from lung adenocarcinoma.Methods A total of 194 patients,including PC(n=94)and lung adenocarcinoma(n=100),confirmed by surgical or puncture pathology were analyzed retrospectively and randomly divided into training set and test set in a ratio of 7∶3.3D Slicer was used to delineate and extract the intranodal and perinodal volume of interest(VOI)radiomics features within a 5 mm range.The minimum redundancy maximum relevance(mRMR)and least absolute shrinkage and selection operator(LASSO)methods were used to dimensionality reduction.Statistically significant indicators were screened by one-way logistic regression and further incorporated into the multifactor logistic regression model.Support vector machine(SVM)was used to construct the intranodal image-based radiomics model,the perinodal image-based radiomics model,the intranodal-and-perinodal image-based radiomics model,and the combined model.The diagnostic efficacy of each model was evaluated by receiver operating characteristic(ROC)curve.Results In the test set,the area under the curve(AUC)of the clinical imaging model,the intranodal image-based radiomics model,the perinodal image-based radiomics model,the intranodal-and-perinodal image-based radiomics model,and the combined model were 0.84,0.88,0.85,0.90,and 0.94,respectively.Conclusion The combined model based on clinical imaging features,intranodal and perinodal radiomics features can improve the ability of differentiating PC from lung adenocarcinoma.

Objective:To evaluate the impact of bladder volume on dosimetric parameters of clinical target volume (CTV) and organs at risk (OAR) of intensity modulated proton therapy (IMPT) for localized prostate cancer during the treatment planning and daily treatment.Methods:Clinical data of 25 patients with localized prostate cancer admitted to Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from November 2021 to June 2022 and enrolled in the "Proton Therapy System" (SAPT-PS-01) registered clinical trial were retrospectively analyzed. All patients were male and the median age was 72 years old. A total of 30 sets of IMPT plans were obtained. Based on the planning CT (30 sets) and weekly verification CT during treatment (172 sets), bladder volume, CTV and OAR dose parameters were collected. Spearman correlation analysis was used to evaluate the correlation between bladder volume in CT and the dosimetric parameters of CTV and OAR during IMPT plans, and Wilcoxon-Mann-Whitney test was adopted to compare the dosimetric parameters of CTV and OAR among different bladder volume change groups.Results:The V 95% of CTV1 and CTV2 were both 100.0%±0.0% in IMPT plans. Bladder volume was significantly negatively correlated with D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE) of the bladder ( P<0.001, 0.003, <0.001, <0.001,<0.001), and D mean, V 50 Gy(RBE) of the small intestine (both P<0.001). During treatment, bladder D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE)( P<0.001, 0.001, <0.001, <0.001, <0.001), rectal D mean, V 50 Gy(RBE), V 40 Gy(RBE) (all P<0.001), small intestine D mean, V 50 Gy (RBE) (both P<0.001) of patients with bladder volume increase >20% compared to baseline were significantly decreased compared to those in IMPT plans. But CTV1 V 100%, and CTV2 V 95% were significantly decreased too( P=0.029, 0.020). In the bladder volume decreased>20% patients, the D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE) of the bladder were significantly increased compared to those in IMPT plans (all P<0.001). However, a bladder volume reduction of ≤20% and increase of ≤20% from baseline had no significant impact on CTV and OAR dosimetric parameters during treatment. Conclusions:For patients with localized prostate cancer undergoing proton therapy, a certain bladder volume should be ensured during planning CT scans. During the daily treatment, the bladder volume should be maintained between 80%-120% of the baseline level to ensure CTV coverage and good dose sparing to OAR.

Objective:To investigate the factors influencing fall risk scores in elderly individuals.Methods:A total of 4 419 individuals were randomly selected using the cluster sampling method from Beijing, Nanning(Guangxi), and Yinchuan(Ningxia).Data on demographic characteristics and fall-related incidents were gathered and analyzed for their correlation with fall risk scores.Results:The fall risk score showed significant associations with various factors, such as the history of falls within one year( β=-3.607, 95% CI: -3.881 to -3.332), care methods( β=2.442, 95% CI: 2.226 to 2.658), exercise( β=0.714, 95% CI: 0.443 to 0.986), retirement( β=-0.585, 95% CI: -0.819 to -0.351), age( β=0.173, 95% CI: 0.159 to 0.187), and use of walking aids( β=-3.737, 95% CI: -4.054 to -3.421). Conclusions:Fall risk scores in older adults are influenced by a variety of factors.Factors such as no history of falls within the past year, living independently, engaging in physical activity, and being employed may contribute to lower fall risk scores in older adults.

Objective:To deeply understand the inner experiences of undergraduate nursing interns using Nursing Information Systems (NIS) and provide references for formulating relevant intervention strategies.Methods:A descriptive phenomenological approach was adopted for this qualitative study. Purposeful sampling was used to select undergraduate nursing interns from four comprehensive hospitals in Hangzhou during February to May 2023 for semi-structured interviews. The interview data were analyzed using Colaizzi's seven-step method to extract themes.Results:Four themes were identified in this study: insufficient preparedness of undergraduate nursing interns in using NIS, low engagement of undergraduate nursing interns in using NIS, perceived benefits of using NIS by undergraduate nursing interns, and adaptation strategies of undergraduate nursing interns using NIS.Conclusions:There are issues such as insufficient preparedness and low engagement among undergraduate nursing interns in using NIS. Some respondents experience emotions such as anxiety, fatigue, and decreased enthusiasm. It is recommended that colleges and internship hospitals pay attention to the clinical work demands and the learning needs of nursing interns, thus providing education and support for the use of NIS.

Purpose: The incidence rate of breast cancer (BC) has increased annually. Downstream neighbor of son (DONSON) critically affects cell cycle progression and maintains stable genomic properties; however, its relevant effects on BC growth and progression require indepth investigation. Methods: DONSON upregulation was validated in public databases. DONSON expression in matched BC and adjacent tissues and cell lines (MDA-MB-231, BT-549, and HS-578T) was determined using quantitative reverse transcription polymerase chain reaction. In vitro apoptosis, invasion, migration, and proliferation tests were performed to ascertain the functions of DONSON in BC cell lines. Then, using western blot analysis, the levels of DONSON downstream proteins were determined. Results: Compared to the control, DONSON was expressed at higher levels in BC tissues and cell lines. DONSON knockdown facilitated apoptosis and limited proliferation, migration, invasion, and S/G2 transition of BC cells In vitro. Furthermore, DONSON overexpression promoted BC cell proliferation and inhibited apoptosis In vitro. Moreover, DONSON knockdown reduced cyclin A1 and cyclin-dependent kinase 2 levels. Moreover, DONSON knockdown limited the progression of epithelial-mesenchymal transition. Conclusion DONSON critically affects BC growth and serves as a possible target and marker for the efficacy of subsequent therapies.

Objective:To analyze the relationship between physical indicators and blood pressure or fasting plasma glucose levels in the young-old and oldest-old.Methods:Totally 1 516 subjects from the Guangxi Natural Longevity Cohort were screened in this study and physical examination parameters included body mass index(BMI), waist circumference(WC), waist-to-height ratio(WHtR), fasting plasma glucose(FPG)and blood pressure, and the correlations between them were analyzed.Results:The overweight elderly and overweight young elderly groups had an increased risk of concurrent hypertension and impaired fasting glucose, compared with both elderly people with normal BMI and young elderly people with normal BMI( OR=2.66, 95% CI: 1.90-3.72; OR=3.03, 95% CI: 2.11-4.34). Elderly people with general obesity and young elderly people with general obesity were more likely to have hypertension( OR=5.25, 95% CI: 2.07-13.28; OR=4.75, 95% CI: 1.84-12.21), impaired fasting glucose( OR=2.95, 95% CI: 1.00-8.69; OR=3.06, 95% CI: 1.04-9.02), and concurrent hypertension and impaired fasting glucose( OR=7.94, 95% CI: 3.04-20.72; OR=8.68, 95% CI: 3.28-22.94), whereas underweight young elderly had a reduced risk of hypertension( OR=0.27, 95% CI: 0.09-0.80). Elderly people in the central obesity group(WC)showed increased risk of hypertension( OR=1.39, 95% CI: 1.04-1.84)and concurrent hypertension and impaired fasting glucose( OR=2.39, 95% CI: 1.75-3.27), compared with those in the non-central obesity group.Young elderly people with central obesity had increased risk of hypertension( OR=1.46, 95% CI: 1.07-2.00), impaired fasting glucose( OR=1.62, 95% CI: 1.14-2.28), and concurrent hypertension and impaired fasting glucose( OR=3.03, 95% CI: 2.13-4.32); both elderly people and young elderly people in the central obesity group(WHtR)had increased risk of hypertension( OR=1.35, 95% CI: 1.03-1.76; OR=1.55, 95% CI: 1.13-2.14), impaired fasting glucose( OR=1.42, 95% CI: 1.04-1.94; OR=1.62, 95% CI: 1.13-2.31), and concurrent hypertension and impaired fasting glucose( OR=2.20, 95% CI: 1.60-3.02; OR=3.22, 95% CI: 2.14-4.84). In the elderly group, BMI was correlated with diastolic blood pressure and WHtR was correlated with the fasting blood glucose level. Conclusions:The levels of fasting plasma glucose and blood pressure increase with elevated physical indicator values(BMI, WC, WHtR)in the Guangxi elderly population, and the risk of developing hypertension, impaired fasting glucose, and concurrent hypertension and impaired fasting glucose increases in elderly patients with general obesity and central obesity, with a higher risk in low-aged elderly patients.

In the special period of COVID-19’s epidemic situation, plastic surgeons are subordinate first and foremost to the national situation and assume the duties that doctors have to cope with in the fight against the epidemic. At the same time, conditions have been created for the provision of professional services to patients who have to undergo emergency plastic treatment, while ensuring the safety of the epidemic. The forum has two components: (1) Presentation of the experience of representative medical institutions in the emergency plastic treatment in a safe manner to prevent epidemics and the safety measures for plastic work in the normal environment of epidemic prevention. (2) A reflection by the plastic surgeons on the professional characteristics and problems at this extraordinary time, and a discussion of the factors affecting the future of plastic surgery industry.

In the special period of COVID-19’s epidemic situation, plastic surgeons are subordinate first and foremost to the national situation and assume the duties that doctors have to cope with in the fight against the epidemic. At the same time, conditions have been created for the provision of professional services to patients who have to undergo emergency plastic treatment, while ensuring the safety of the epidemic. The forum has two components: (1) Presentation of the experience of representative medical institutions in the emergency plastic treatment in a safe manner to prevent epidemics and the safety measures for plastic work in the normal environment of epidemic prevention. (2) A reflection by the plastic surgeons on the professional characteristics and problems at this extraordinary time, and a discussion of the factors affecting the future of plastic surgery industry.