Systematic analysis and modeling of the FLASH sparing effect as a function of dose and dose rate

Ultrahigh-dose-rate radiotherapy(FLASH-RT)is a revolutionary radiotherapy technology that can spare normal tissues without compromising tumor control.Although qualitative experimental results have been reported,quantitative and systematic analysis of data is necessary.Particularly,the FLASH effect response model to the dose or dose rate is still unclear.This study investigated the relationships between the FLASH effect and experimental parameters,such as dose,dose rate,and other factors by analyzing published in vivo experimental data from animal models.The data were modeled based on logistic regression analysis using the sigmoid function.The model was evaluated using prediction accuracy,receiver operating characteristic(ROC)curve,and area under the ROC curve.Results showed that the FLASH effect was closely related to the dose,mean dose rate,tissue type,and corresponding biological endpoints.The dose rate corresponding to a 50% probability of triggering cognitive protection in the brain was 45 Gy s^(-1).The dose rate corresponding to a 50% probability of triggering intestinal crypt survival and regeneration was 140 Gy s^(-1).For the skin toxicity effect,the dose corresponding to a 50% probability of triggering the FLASH effect was 24 Gy.This study helps to characterize the conditions underlying the FLASH effect and provides important information for optimizing experiments.

Clinical effects of nonconvulsive electrotherapy combined with mindfulness-based stress reduction and changes of serum inflammatory factors in depression

BACKGROUND Depression is a common and serious psychological condition,which seriously affects individual well-being and functional ability.Traditional treatment methods include drug therapy and psychological counseling;however,these methods have different degrees of side effects and limitations.In recent years,nonconvulsive electrotherapy(NET)has attracted increasing attention as a noninvasive treatment method.However,the clinical efficacy and potential mechanism of NET on depression are still unclear.We hypothesized that NET has a positive clinical effect in the treatment of depression,and may have a regulatory effect on serum inflammatory factors during treatment.AIM To assess the effects of NET on depression and analyze changes in serum inflammatory factors.METHODS This retrospective study enrolled 140 patients undergoing treatment for depression between May 2017 and June 2022,the observation group that received a combination of mindfulness-based stress reduction(MBSR)and NET treatment(n=70)and the control group that only received MBSR therapy(n=70).The clinical effectiveness of the treatment was evaluated by assessing various factors,including the Hamilton Depression Scale(HAMD)-17,self-rating idea of suicide scale(SSIOS),Pittsburgh Sleep Quality Index(PSQI),and levels of serum inflammatory factors before and after 8 wk of treatment.The quality of life scores between the two groups were compared.Comparisons were made using t and χ^(2) tests.RESULTS After 8 wk of treatment,the observation group exhibited a 91.43%overall effectiveness rate which was higher than that of the control group which was 74.29%(64 vs 52,χ^(2)=7.241;P<0.05).The HAMD,SSIOS,and PSQI scores showed a significant decrease in both groups.Moreover,the observation group had lower scores than the control group(10.37±2.04 vs 14.02±2.16,t=10.280;1.67±0.28 vs 0.87±0.12,t=21.970;5.29±1.33 vs 7.94±1.35,t=11.700;P both<0.001).Additionally,there was a notable decrease in the IL-2,IL-1β,and IL-6 in both groups after treatment.Furthermore,the observation group exhibited superior serum inflammatory factors compared to the control group(70.12±10.32 vs 102.24±20.21,t=11.840;19.35±2.46 vs 22.27±2.13,t=7.508;32.25±4.6 vs 39.42±4.23,t=9.565;P both<0.001).Moreover,the observation group exhibited significantly improved quality of life scores compared to the control group(Social function:19.25±2.76 vs 16.23±2.34;Emotions:18.54±2.83 vs 12.28±2.16;Environment:18.49±2.48 vs 16.56±3.44;Physical health:19.53±2.39 vs 16.62±3.46;P both<0.001)after treatment.CONCLUSION MBSR combined with NET effectively alleviates depression,lowers inflammation(IL-2,IL-1β,and IL-6),reduces suicidal thoughts,enhances sleep,and improves the quality of life of individuals with depression.

A Study of the Teaching Effects of Case Analysis in Cross-Cultural Communication Class-Taking Individualism-Collectivism Cultural Dimension Class as an Example

This study introduces the individualism-collectivism dimension of the cultural dimension of cross-cultural communication initiated by Geert Hofstede.Different cultures must develop a way of correlating that strikes a balance between caring for themselves and showing concern for others.Individualist culture encourages uniqueness and independence while collectivist culture emphasizes conformity and mutual assistance.This article introduces how to use case analysis method to effectively carry out classroom teaching in this cultural dimension.

Observation of the Clinical Effects of Detailoriented Nursing in Health Checkups at a Health Management Center

Objective:To observe the clinical effects of detail-oriented nursing in health checkups at a health management center.Methods:A total of 240 individuals undergoing health checkups at the hospital’s health management center from June 2023 to June 2024 were enrolled and randomly divided into two groups according to a random number table method.The control group received routine nursing care,while the observation group received detail-oriented nursing care,with 120 cases in each group.Differences in checkup quality and nursing risk incidence were compared.Results:The form submission rate,project completion rate,and one-time checkup completion rate in the observation group were higher than those in the control group,while the checkup time was shorter(P<0.05).The incidence of nursing risks such as item loss,falls,and patient-nurse disputes was lower in the observation group compared to the control group(P<0.05).Conclusion:Applying detail-oriented nursing in health checkups at a health management center can effectively improve checkup quality and reduce the occurrence of nursing risks.

Comparison of the Clinical Effect of Prefabricated Fiber Post and Plastic Fiber Post in Oral Repair

Objective:To observe and analyze the clinical effect of prefabricated fiber posts and plastic fiber posts in oral repair.Methods:A total of 128 patients admitted to our hospital from January 2023 to June 2024 underwent oral prosthesis treatment,of which the control group(n=64)was treated with prefabricated fiber posts and the observation group(n=64)with plastic fiber posts.The efficacy,retention rate,and complication rate of the two groups were compared.Results:The total effective rate of the observation group was 96.88%,which was significantly higher than that of the control group(84.38%)(P<0.05).The restoration retention rate in the observation group was 95.31%,which was significantly higher than that in the control group(85.94%)(P<0.05).The incidence of postoperative complications in the observation group was 4.69%,which was significantly lower than that in the control group(15.63%)(P<0.05).Conclusion:For patients with oral prostheses,the use of plastic fiber posts for treatment shows better clinical effects,effectively improving the retention rate of the prosthesis and reducing the incidence of complications.Thus,it is worthy of popularization and application.

Analysis of the Effect of Humanistic Care in the Process of Pre-Hospital Emergency Care

Objective:To explore the effectiveness of humanistic care in pre-hospital emergency care.Methods:From April 2020 to January 2021,80 pre-hospital emergency patients were studied.The patients were randomly divided into two groups:a control group(n=40),which received conventional care,and an experimental group(n=40),which received humanistic care.The effects of nursing care and psychological state were compared between the two groups.Results:The experimental group showed better nursing outcomes and a more positive psychological state compared to the control group(P<0.05).Conclusion:Humanistic care in pre-hospital emergency settings is more effective in reducing patients’anxiety and depression,enhancing the operational abilities and service attitudes of nursing staff,and increasing the emergency success rate.

Analysis of the Current Situation of Drug Clinical Trial Institutions in Shaanxi Province

To understand the current situation of institutional registration in Shaanxi Province after the implementation ofregistration system management in drug clinical trial institutions.Relevant information was collected on the“Announcement on the Accreditation of Drug Clinical Trial Institutions”issued by the National Medical Products Administration from 2005 to August 2022,the record management information system of drug and medical device clinical trial institutions,and the drug clinical trial registration and information publicity platform.A retrospective analysis was carried out in terms of institutional development,regional distribution,registered majors,principal investigators,and the number of drug clinical trials.After the implementation of institution registration,the number of drug clinical trial institutions in Shaanxi Province increased by 47.4%,884 principal investigators were registered,the number of registered majors expanded from 58 qualified to 117,and the professional scope increased by 50.4%.The policy of institution registration is conducive to promoting the rational use of medical resources and the development of drug clinical trial institutions and improving the healthy development of the pharmaceutical industry in Shaanxi Province.

The value of toxicological analysis in acute poisoning patients with uncertain exposure histories:a retrospective and descriptive study from an institute of poisoning

BACKGROUND:In clinical practice,some patients might not be able or unwilling to provide a thorough history of medication and poison exposure.The aim of this study was to use toxicological analysis to examine the clinical characteristics of patients with acute poisoning whose exposure history was uncertain from a toxicological analysis perspective.METHODS:This was a retrospective and descriptive study from an institute of poisoning.Patient registration information and test reports spanning the period from April 1,2020 to March 31,2022,were obtained.Patients with uncertain exposure histories and who underwent toxicological analysis were included.Clinical manifestations and categories of toxics were analyzed.RESULTS:Among the 195 patients with positive toxicological analysis results,the main causes of uncertain exposure history was disturbance of consciousness(62.6%),unawareness(23.6%)and unwillingness or lack of cooperation(13.8%).The predominant clinical manifestations were disturbed consciousness(62.6%),followed by vomiting and nausea(14.4%)and liver function abnormalities(8.7%).A comparison of clinical manifestations between patients with positive and negative(n=99)toxicological analyses results revealed significantly different proportions of disturbances in consciousness(63%vs.21%),dizziness(1.5%vs.5.1%),multi-organ failure(1.5%vs.7.1%),and local pain(0 vs 4%).The main categories of substances involved were psychiatric medications(23.1%),sedatives(20.5%),insecticides(13.8%),and herbicides(12.8%).CONCLUSION:The clinical manifestations of acute poisoning in patients with an uncertain exposure history are diverse and nonspecific,and toxicological analysis plays a pivotal role in the diagnosis and differential diagnosis of such patients.

Effect of CBL Combined with Case Analysis in the Teaching of Clinical Anesthesia

Objective:To evaluate the effect of CBL(case-based learning)combined with case analysis in the teaching of clinical anesthesia.Methods:From June 2018 to June 2020,a total of 100 clinical anesthesia interns in Shaanxi Provincial People’s Hospital were selected as the research subjects.They were divided into two groups,the reference group(50 interns)and the study group(50 interns),by random sampling method.The reference group was under the traditional teaching method,whereas for the study group,CBL combined with case analysis was implemented.The teaching satisfaction and achievement of the interns in both the groups were evaluated.Results:The teaching satisfaction of the study group was 98%,which was significantly higher than that of the reference group(86%)(P<0.05);before teaching,there was no significant difference in the theoretical and clinical practice scores between the two groups(P>0.05);however,after teaching,the theoretical and clinical practice scores of the two groups increased significantly,in which the change of the research group was significantly greater than that of the reference group(P<0.05).Conclusion:The application of CBL combined with case analysis in the teaching of clinical anesthesia has an ideal effect,improving the teaching satisfaction and achievement.It is a high-quality teaching method and is worthy of application.

Analysis on the Clinical Effects of Emergency Surgical Treatment on Patients with Acute Abdominal Pain

Objective:To study the clinical effects of emergency surgery in treating patients with acute abdominal pain.Methods:60 patients admitted to our hospital between January 2019 and December 2019 were randomly selected as subjects,and the incidence of complications and mortality of the patients were observed.Results:Among the 60 patients,definitive diagnosis was obtained during the operation and there was no mortality.After the operation,they were transferred to other relevant departments for continued treatment.Among the 60 patients,4 cases had complications,accounted for incidence of 6.67%.Conclusion:The diagnosis of emergency surgical treatment based on acute abdominal pain avoided misdiagnosis and realized non-invasive diagnosis,and provided a valid reference for avoiding overtreatment.

Meta-Analysis of the Clinical Effect of Acupuncture on Postherpetic Neuralgia

Objective:To systematically evaluate the safety and efficacy of acupuncture on patients with postherpetic neuralgia.Methods:Based on the heyword retrieval method,China National Knowledge Infrastructure(CNKI,1978-2020),China Biomedical Literature database(CBM,1979-2020),VIP database(WEIPU,1989-2020),Wanfang database(1989-2020),Cochrane Library,PubMed,and Embase were searched;randomized controlled trials of the use of acupuncture in the treatment of postherpetic neuralgia were screened out;the quality of the included literatures was evaluated based on the evaluation criteria in the Cochrane Handbook,and meta-analysis was performed using RevMan 5.3.Results:Twenty-six literatures that met the criteria,involving 2,174 patients,were included;the meta-analysis showed that compared with western medicine,the use of acupuncture can improve the overall effective rate(RR=1.24,95%CI[1.17,1.32],P<0.00001)and reduce the VAS score(MD=-1.43,95%CI[-1.97,-0.89],P<0.00001).Conclusion:The use of acupuncture can further improve the clinical effect of patients with postherpetic neuralgia.

Effects of postoperative treatment with chemotherapy and cellular immunotherapy on patients with colorectal cancer

BACKGROUND The outcome of surgical treatment for colorectal cancer(CRC)remains unsatis-factory and warrants further exploration and optimization.AIM To clarify the impact of chemotherapy plus cellular immunotherapy[dendritic cell-cytokine-induced killer(DC-CIK)cell immunotherapy]on patients after CRC surgery and to explore the mediating variables.METHODS A total cohort of 121 patients who underwent CRC surgery between January 2019 and April 2022 were selected.The sample comprised a control group of 55 pa-tients who received the XELOX chemotherapy regimen and a research group of 66 patients who received XELOX+DC-CIK immunotherapy.We performed compa-rative analyses of the clinical and pathological data of the two groups,including efficacy(2-year disease-free survival[DFS]rate),the incidence of adverse events(diarrhea,myelosuppression,gastrointestinal reactions,and peripheral neuritis),serum levels of tumor markers[carcinoembryonic antigens and carbohydrate an-tigens(CA)19-9 and CA242],and T-cell subsets[cluster of differentiation(CD)3+,CD3+CD4+,CD3+CD8+,natural killer(NK),and NK T cells].We also conducted preliminary univariate and mul-tivariate analyses of the variables that affected the efficacy of the treatments.RESULTS We found a significantly higher 2-year DFS rate of treatment efficacy in the research group than in the control group,with a statistically lower incidence of adverse events.Both groups showed a reduction in serum tumor markers after treatment but there was no marked intergroup difference.After treatment,the various T-cell subgroup indicators in the control group were significantly lower than those in the research group.The indices of T-cell subsets in the research group showed no significant change from preoperative levels.Univariate analysis revealed a significant correlation between TNM staging,tumor differentiation,and the rates of nonresponse to treatment in CRC patients after surgery.Multivariate results indicated that the treatment approach significantly affected the efficacy of postoperative CRC treatment.CONCLUSION We concluded that XELOX+DC-CIK immunotherapy for postsurgical CRC patients offers reduced rates of treatment-induced adverse events,extended 2-year DFS,enhanced immunity,and increased physiological antitumor responses.

Decoupling of temporal/spatial broadening effects in Doppler wind LiDAR by 2D spectral analysis

Pulse echo accumulation is commonly employed in coherent Doppler wind LiDAR(light detection and ranging)under the assumption of steady wind.Here,the measured spectral data are analyzed in the time dimension and frequency dimension to cope with the temporal wind shear and achieve the optimal accumulation time.A hardware-efficient algorithm combining the interpolation and cross-correlation is used to enhance the wind retrieval accuracy by reducing the frequency sampling interval and then reduce the spectral width calculation error.Moreover,the temporal broadening effect and spatial broadening effect are decoupled according to the strategy we developed.

Effect of boundary conditions on shakedown analysis of heterogeneous materials

The determination of the ultimate load-bearing capacity of structures made of elastoplastic heterogeneous materials under varying loads is of great importance for engineering analysis and design. Therefore, it is necessary to accurately predict the shakedown domains of these materials. The static shakedown theorem, also known as Melan's theorem, is a fundamental method used to predict the shakedown domains of structures and materials. Within this method, a key aspect lies in the construction and application of an appropriate self-equilibrium stress field(SSF). In the structural shakedown analysis, the SSF is typically constructed by governing equations that satisfy no external force(NEF) boundary conditions. However, we discover that directly applying these governing equations is not suitable for the shakedown analysis of heterogeneous materials. Researchers must consider the requirements imposed by the Hill-Mandel condition for boundary conditions and the physical significance of representative volume elements(RVEs). This paper addresses this issue and demonstrates that the sizes of SSFs vary under different boundary conditions, such as uniform displacement boundary conditions(DBCs), uniform traction boundary conditions(TBCs), and periodic boundary conditions(PBCs). As a result, significant discrepancies arise in the predicted shakedown domain sizes of heterogeneous materials. Built on the demonstrated relationship between SSFs under different boundary conditions, this study explores the conservative relationships among different shakedown domains, and provides proof of the relationship between the elastic limit(EL) factors and the shakedown loading factors under the loading domain of two load vertices. By utilizing numerical examples, we highlight the conservatism present in certain results reported in the existing literature. Among the investigated boundary conditions, the obtained shakedown domain is the most conservative under TBCs.Conversely, utilizing PBCs to construct an SSF for the shakedown analysis leads to less conservative lower bounds, indicating that PBCs should be employed as the preferred boundary conditions for the shakedown analysis of heterogeneous materials.

Leading directions and effective distance of larch offspring dispersal at the upper treeline in the Northern and Polar Urals, Russia

Climate has changed sufficiently over the last 150 years and forced out upper treeline advance at the most studied sites around the world.The rate of advance has been extremely variable–from tens to hundreds meters in altitude.This is because the degree at which tree frontal populations respond to climate change depends on the complex interaction of biological and physical factors.The resulting stand pattern is the consequence of the interaction between dispersal and survival functions.A few publications have addressed the question of how this pattern is generated.In order to understand how the spatial structure of tree stands was formed at the upper limit of their distribution in the Ural Mountains,we assessed the distance and direction of dispersal of offspring from maternal individuals.We found that in frontal Larix sibirica Ledeb.populations,‘effective’dispersal of offspring ranges from 3 to 758 m(with a median of 20–33 m in open forest and 219 m in single-tree tundra in the Polar Urals and 107 m in open forest in the Northern Urals).We revealed that most of the offspring effectively dispersed not only in the direction of the prevailing winds,but also in the opposite direction up the slope,and the distance can reach 500–760 m.The data obtained can be used to develop an individual-based model which is capable of simulating in detail the dynamics of tree stands at the upper limit of their growth and reliably predicting the future position and pattern of treeline ecotone as growth conditions continue to improve in the face of observed climate change.

Appropriateness of Amikacin Dose Prescription, Monitoring and Safety during Hospitalization as an Impact of Clinical Pharmacologist Intervention, in the Israeli Regional Hospital

Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are the analysis of amikacin dose, serum level and the examination of the effectiveness of the clinical pharmacologist (CP) therapeutic drug monitoring (TDM) intervention to guarantee the safety of amikacin use. Methods: This is a one-year retrospective observational chart review study, which evaluates amikacin dose, serum drug level, development of adverse effects in patients on amikacin with or without CP TDM consultation. Results: Amikacin was prescribed for 393 complex patients, with median age 83. Amikacin group (AG) included 140 (32%) courses with CP consultation (AG1) and 292 (68%) courses without CP consultation (AG2). The distribution of most study characteristics in both groups was similar including amikacin dose (9-10 mg/kg/day), renal failure (14%) and mortality (12%). Acceptance for CP consultation was in 46% of amikacin courses and dose changes were done in 63% after CP intervention. Prolonged antibiotic course (4.6 ± 1.5 vs 3.8 ± 1.6 days, p < 0.0001) and the patient’s hemodynamic instability (15% vs 7%, p = 0.01) were more frequent in the AG1 compared to the AG2. There was a strong association between CP consultation and prolonged hospitalization (p = 0.005), while no association between it and amikacin adverse effects, renal failure or mortality. Conclusions: There was no trend to reducing amikacin toxicity, days of hospitaliza tion or mortality in patients with CP consultation. CP TDM intervention was more in the management of complicated clinical situations. However, it is necessary to optimize it.

The Role of the Size Effect on the Drying of Refractory Castables—How Its Under-standing Could Narrow the Gap between Laboratory Studies and Industrial Reality

Refractories have unique capabilities such as sustaining their shape and properties at extreme conditions such as the combination of high temperatures and thermal shock,contact with molten metals and slags and in some circumstances resistance to erosion from abrasive particles.Given the large processing output of the heavy industries such as the cement and steel ones which both require high temperature processes,the refractories structures span various meters and weight of several tons.As the water removal stage of hydraulic bonded castables in industrial sites takes hours(10-60 h)due to the risk of explosive spalling,efforts to mitigate it are commonly studied.This has provided theoretical understanding of the general aspects of drying and important tools,such as the thermogravimetry analysis(TGA),for the design of refractory compositions with higher explosive spalling resistance.However,the optimization of this process is still far from the industrial reality especially because the actual linings that require the drying are orders of magnitude larger than the samples considered in the laboratory tests.Therefore,this study proposed the analysis of the sample volume effect on the water removal dynamics through TGA of high alumina castables with calcium aluminate cement.Conventionalφ5 cm×5 cm cylindrical samples were assessed in a laboratory scale equipment whereas macro TGA were carried out considering 20 cm×20 cm×20 cm and 30 cm×30 cm×30 cm cubic samples.Additionally,the effect of polymeric fibers was also considered.It was found out that the different thermal gradients within the macro TGA samples resulted in an inflection on the sample’s heating rate and that the mass loss was affected by the volume considered,especially for the composition without additives.These findings highlight the requirement of carefully taking into consideration the different dimensional sizes and thermal gradients in the samples when analyzing and interpreting the laboratory studies,and especially when trying to extrapolate such results to the industrial reality.

Intraoperative thermostatic nursing and failure mode and effects analysis enhance gastrectomies’ care quality

BACKGROUND Utilizing failure mode and effects analysis(FMEA)in operating room nursing provides valuable insights for the care of patients undergoing radical gastric cancer surgery.AIM To evaluate the impact of FMEA on the risk of adverse events and nursing-care quality in patients undergoing radical surgery.METHODS Among 230 patients receiving radical cancer surgery between May 2019 and May 2024,115 were assigned to a control group that received standard intraoperative thermoregulation,while the observation group benefited from FMEA-modeled operating room care.Clinical indicators,stress responses,postoperative gastroin-testinal function recovery,nursing quality,and the incidence of adverse events were compared between the two groups.RESULTS Significant differences were observed in bed and hospital stay durations between the groups(P<0.05).There were no significant differences in intraoperative blood loss or postoperative body temperature(P>0.05).Stress scores improved in both groups post-nursing(P<0.05),with the observation group showing lower stress scores than the control group(P<0.05).Gastrointestinal function recovery and nursing quality scores also differed significantly(P<0.05).Additionally,the incidence of adverse events such as stress injuries and surgical infections varied notably between the groups(P<0.05).CONCLUSION Incorporating FMEA into operating room nursing significantly enhances patient care by improving safety,expediting recovery,and reducing healthcare-associated risks.

Demand and Analysis of Clinical Research Curriculum in Medical Universities

Objective:To investigate the needs of medical students regarding clinical research curricula to provide scientifically sound offerings and cultivate their clinical research thinking.Methods:From June to October 2022,medical students at medical universities in Shaanxi Province were surveyed using online questionnaires.The survey covered their demographic information,awareness of their major,understanding of clinical research,and preferences for curriculum content.Results:A total of 341 valid questionnaires were analyzed.Medical students demonstrated a strong awareness of their majors but a relatively low awareness of clinical research.There was significant demand for clinical research courses,with preferences for professionally oriented(81.8%),market-oriented(100%),theoretically and practically integrated teaching(78.6%),and application-focused(73.0%)courses.Conclusion:Medical colleges and universities should align clinical research curricula with the actual needs of medical students and clinical practice.Reforms in curriculum design and teaching methods are essential to better prepare students for careers in public health.