To evaluate the clinical efficacy of an optimized pelvic immobilization protocol—combining a locked headrest with knee wedge removal—on setup accuracy and planning target volume (PTV) margins in rectal cancer patients undergoing VMAT in the supine position.

We retrospectively analyzed 159 fractions of cone-beam CT (CBCT) registration data from 53 patients with rectal cancer treated with pelvic volumetric modulated arc therapy (VMAT) between December 2020 and December 2025. Patients were assigned to three cohorts: Group A (n=15) used the “non-fixed headrest + knee wedge” fixation scheme; Group B (n=18) used the “locked headrest + knee wedge” fixation scheme; Group C (n=20) used the “locked headrest + knee wedge removed” fixation scheme. Six-dimensional (Vrt, Lng, Lat, Pitch, Roll, Rtn) setup errors were collected. One-way ANOVA with LSD post-hoc tests and Mann-Whitney U tests were employed to compare individual systematic errors and random errors among the groups. Abnormal setup was defined as any linear shift >5.00 mm or rotation >2.00°. PTV margins in three translational directions were determined using the van Herk formula (Margin = 2.5Σ + 0.7σ).

One-way ANOVA revealed significant differences in systematic Vrt (F = 15.89, P<0.01) and Roll (F = 3.87, P = 0.03) bias among the three groups with Group C demonstrating systematic means closest to the absolute zero center (Vrt: -0.28 mm, Roll: 0.01°). Group C achieved the lowest group systematic error (Σ) in Lng (1.14 mm vs. 1.79 mm in Group A and 1.98 mm in Group B) and Lat directions (1.43 mm vs. 1.54 mm in Group A and 2.84 mm in Group B). For random errors, Group C achieved significantly smaller Pitch rotational variation compared to Group A (Z = -2.47, P = 0.01). The abnormal setup rate in Group C was 3.33%, significantly lower than 31.11% in Group A and 22.22% in Group B (χ² = 14.87, P<0.01). PTV margins for Group C in the Vrt, Lng, and Lat directions were safely contracted to 3.58 mm, 5.65 mm, and 6.47 mm, respectively, with the maximum narrowing of 35.50% compared to Group A.

The optimized pelvic immobilization protocol utilizing a locked headrest and removing the knee wedge significantly enhances the geometric reproducibility of VMAT setups for rectal cancer by stabilizing the spinal kinetic chain and engaging the knee screwing-home mechanism. This cost-free approach effectively compresses PTV margins and enhances organ-at-risk (OAR) sparing, making it highly recommended as a standardized protocol for supine pelvic radiotherapy.

To explore the qualitative diagnostic value of superb microvascular imaging (SMI) combined with contrast-enhanced ultrasound (CEUS) for liver space occupying lesions.

The clinical data of 115 patients with liver space occupying lesions who were admitted to our hospital from January 2023 to December 2025 were retrospectively collected. All patients underwent SMI and CEUS examinations, with surgical or puncture pathology results as the gold standard. The qualitative diagnostic results of SMI and CEUS alone and in combination for liver mass lesions were calculated, including the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and consistency K value. The diagnostic accuracy of SMI and CEUS alone and in combination for different subgroups of liver mass lesions was analyzed. Based on the conventional ultrasound characteristics of different liver occupying lesions, a regression model was constructed and validated using Bootstrap self sampling, Hosmer-Lemeshow goodness of fit test, and decision curve.

In 115 patients with liver mass lesions, 48 were diagnosed with malignant lesions and 67 with benign lesions based on surgical or puncture pathology results. The pathological results of surgery or puncture were the gold standard, and the detection rates of SMI, CEUS alone, and in combination for malignant liver lesions were 75.00%, 70.83%, and 95.83%, respectively. The sensitivity, accuracy, and negative predictive value of SMI combined with CEUS were higher than those of SMI and CEUS alone, and the K value was the highest, at 0.757, with statistical significance differences (P<0.05). In the subgroup of lesions ≤ 3 cm, the accuracy of SMI and CEUS diagnosis alone was lower than that of combined diagnosis; in the subgroup of hepatocellular carcinoma, the accuracy of CEUS diagnosis alone was lower than that of combined diagnosis, all with statistical significant differences (P<0.05). The proportion of internal high echo, posterior echo attenuation, irregular morphology, and unclear boundaries in the malignant group was higher than that in the benign group (P<0.05). The results of Logistic regression analysis showed that SMI combined with CEUS diagnosis, internal echo, posterior echo, morphology, and boundary were all influencing factors of malignant liver lesions (P<0.05). Based on this, a regression model was constructed, and the internal validation results showed that the consistency index of the model was 0.955 (95% CI: 0.940~0.962). The fit between the internal calibration curve and the ideal curve was well reflected. The Hosmer-Lemeshow goodness of fit test results showed that the predicted outcome of the model was basically consistent with the actual situation (χ²=4.162, P=0.526). According to the decision curve evaluation, the model had a high net return rate within the threshold probability range of 0.01~0.09 and 0.33~0.93, with a maximum net return rate of 0.414.

SMI combined with CEUS has high qualitative diagnostic value for liver space occupying lesions and can assist clinical decision-making.

To investigate the value of transient elastography in predicting the severity of gastroesophageal varices (GOV) in patients with liver cirrhosis.

A total of 502 patients with liver cirrhosis from two centers were enrolled. Based on endoscopic findings, they were classified into four groups: no GOV, mild GOV, moderate GOV, and severe GOV. Platelet count (PLT), prothrombin time (PT), and abdominal ultrasound parameters were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for the occurrence and progression of GOV. Liver stiffness measurement (LSM) was obtained using transient elastography, and its distribution across different GOV grades was analyzed. The predictive performance of LSM combined with PLT and spleen diameter (SD) for GOV severity was evaluated using receiver operating characteristic (ROC) curve analysis.

Among the 502 patients with liver cirrhosis, 356 cases had GOV. Multivariate logistic regression showed that PLT and SD were independent risk factors for both the occurrence and progression of GOV (both P<0.05). LSM values in the mild and moderate GOV groups were significantly higher than those in the no GOV group (both P<0.01), but no significant differences were observed among the mild, moderate, and severe GOV groups. In stratified analyses combining LSM with PLT and SD, the proportion of low-risk combinations (PLT>150×10⁹/L and LSM<15 kPa; or SD<10 cm and LSM 15~25 kPa) decreased progressively with increasing GOV severity, whereas the proportion of high-risk combinations (LSM>25 kPa with PLT 100~150×10⁹/L or SD>15 cm) increased significantly. ROC curve analysis showed that the combination of LSM, PLT, and SD achieved an AUC of 0.843 for predicting moderate to severe GOV, which was superior to LSPS.

Transient elastography combined with PLT and SD measured by abdominal ultrasound can accurately predict the occurrence of moderate and severe GOV in patients with liver cirrhosis, and can be used to identify high-risk populations for esophageal and gastric variceal rupture bleeding.

To investigate the role of oxygen-inhalation and sputum-suction devices in the treatment of patients with severe pulmonary infection under evidence-based intervention.

From January 2022 to January 2024, 80 patients with severe pulmonary infection in Heze Municipal Hospital were observed. According to the different treatment devices used, 80 patients were divided into conventional group and study group, with 40 patients in each group. Patients in the conventional group received conventional oxygen inhalation and sputum suction methods; patients in the study group used an integrated oxygen and sputum suction device and operated under the guidance of evidence-based intervention, including the formulation of evidence-based questions, evidence retrieval and quality evaluation, transformation and implementation of evidence-based plans, dynamic monitoring and continuous improvement. Symptom resolution, blood gas index, clinical pulmonary infection score (CPIS), total number of sputum aspiration and sputum purification time were compared between the two groups after treatment.

The duration of cough cessation, the disappearance time of wheezing and stridor in the research group were shorter than those in the conventional group, and the difference was statistically significant (P < 0.05). Before treatment, there was no statistically significant difference in arterial blood oxygen partial pressure and oxygen saturation between the conventional group and the research group (P > 0.05); after treatment, the arterial blood oxygen partial pressure and oxygen saturation of both groups increased, and those in the research group were higher, with a statistically significant difference (P < 0.05). Before treatment, there was no statistically significant difference in CPIS scores between the conventional group and the research group (P > 0.05); after treatment, the CPIS scores of both groups decreased, and those in the research group were lower, with a statistically significant difference (P < 0.05). The total number of sputum aspiration and sputum purification time in the research group were less than those in the conventional group, with a statistically significant difference (P < 0.05).

With evidence-based intervention, the use of integrated oxygen and sputum suction device can effectively relieve the symptoms of cough, wheezing and stridor in patients with severe pulmonary infection, improve the partial pressure of arterial blood oxygen and blood oxygen saturation, and help to improve the respiratory function and oxygenation of patients.

To explore the application effect of endoscopic over-the-scope clip (OTSC) anastomosis clip hemostasis therapy in patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB).

A total of 302 patients with ANVUGIB admitted to our hospital from October 2023 to August 2025 were selected as the research subjects. They were randomly divided into the control group and the observation group, with 151 cases in each group. The control group received endoscopic metal titanium clip hemostasis, while the observation group received endoscopic OTSC anastomosis clip hemostasis therapy. The hemostasis effect, stress response, inflammatory indicators, and adverse reactions were compared between the two groups.

The hemostasis time of the observation group was (4.12±1.08) min, which was shorter than that of the control group [(10.33±2.61) min]. The immediate hemostasis rate was 98.01% (148/151), which was higher than that of the control group [90.07% (136/151)], and the rebleeding rate within 7 days was 1.32% (2/151), which was lower than that of the control group [6.62% (10/151)], and the differences were statistically significant (P<0.05). After treatment, the cortisol (Cor) of the observation group was (282.62±39.66) nmol/L, interleukin-6 (IL-6) was (18.12±3.25) pg/mL, tumor necrosis factor-α (TNF-α) was (22.46±4.81) pg/mL, and C-reactive protein (CRP) was (5.12±1.26) mg/L, which were lower than those of the control group [(308.96±45.18) nmol/L, (27.11±3.94) pg/mL, (31.05±5.78) pg/mL, and (8.45±1.44) mg/L], and the differences were statistically significant (P<0.05); the incidence of adverse reactions in the observation group was 2.65% (4/151), which was lower than that of the control group [7.95% (12/151)], and the difference was statistically significant (P<0.05).

Endoscopic OTSC anastomosis clip hemostasis therapy for ANVUGIB has a definite hemostatic effect, can relieve stress response, reduce inflammatory levels, and has good safety.

To analyze the application effect of CT digital 3D reconstruction and personalized 3D printing guide plate in total hip arthroplasty for hip dysplasia.

Sixty patients with hip dysplasia who underwent total hip catheterization in our hospital from January 2023 to January 2025 were selected as the research subjects. They were divided into the control group and the observation group by the random number table method, with 30 cases in each group. The control group underwent routine surgical planning before the operation, while the observation group used CT digital three-dimensional reconstruction and individualized 3D printed guide plates for surgical planning before the operation. The surgery-related indicators of the two groups, as well as the coverage rate of acetabular prosthesis, the coverage rate of transplanted bone, and the qualified rate of acetabular cup position were statistically analyzed. The incidence of prosthesis related complications after the operation in the two groups was also statistically analyzed.

The intraoperative blood loss and postoperative drainage volume in the observation group were (337.50±11.39) mL and (192.00±9.33) mL respectively, both of which were less than those in the control group [(378.07±10.89) mL and (218.80±8.19) mL], and the differences were statistically significant (P<0.05). The operation time and the indwelling time of the postoperative drainage tube in the observation group were (82.93±2.64) min and (1.83±0.14) d respectively, which were both shorter than those in the control group [(93.50±3.37) min and (2.53±0.09) d], and the differences were statistically significant (P<0.05). The coverage rate of acetabular prosthesis, the coverage rate of transplanted bone and the qualified rate of acetabular cup position in the observation group were (93.07±0.74)%, (75.10±1.52)% and 96.67% respectively, which were all higher than those in the control group [(89.93±1.02)%, (69.37±1.47)% and 80.00%] The difference was statistically significant (P<0.05). The total incidence of prosthis-related complications such as prosthesis infection, prosthesis loosening and joint dislocation after surgery in the observation group was 3.33%. It was lower than 23.33% of the control group, and the difference was statistically significant (P<0.05).

The application of CT digital three-dimensional reconstruction and individualized 3D printing guide plate in total hip arthroplasty for developmental dysplasia of the hip has a certain significance in improving the efficiency of operation and postoperative recovery. It can improve the coverage rate of acetabular prosthesis, the coverage rate of bone graft and the qualified rate of cup position, and reduce complications.

To investigate the clinical efficacy of low-power high-intensity focused ultrasound (HIFU) combined with medium-frequency breast therapy device in the treatment of severe lactational mastitis and its impact on immune function.

A retrospective randomized controlled study was conducted, including 208 patients with severe lactational mastitis admitted from January 2021 to January 2024. Patients were divided into combined treatment group (104 cases, low-power HIFU + medium-frequency breast therapy device) and control group (104 cases, conventional treatment). The fever clearance time, milk flow rate, visual analogue scale (VAS) pain score, and peripheral blood NK cell activity and inflammatory factor levels were compared between the two groups.

The fever clearance time in the combined treatment group was (2.89±1.25) days, significantly shorter than (5.21±1.58) days in the control group (P<0.001). The milk flow rate was 94.23%, significantly higher than 76.92% in the control group (P<0.001). The VAS pain score after treatment decreased to (2.02±0.32) points, significantly lower than (3.56±1.17) points in the control group (P<0.001). The activity of NK cells significantly increased (P<0.001), and was significantly higher than that of the control group (P<0.001). The levels of serum IL-6 and TNF-α significantly decreased (P<0.001), and were significantly lower than those of the control group (P<0.001).

Low-power HIFU combined with medium-frequency breast therapy device can significantly shorten the course of severe lactational mastitis and improve clinical symptoms. The mechanism may be related to regulating immune function and reducing inflammatory response.

To establish a prediction model for the conversion risk from mild cognitive impairment (MCI) to Alzheimer's disease (AD) based on structural MRI features, and employ interpretable algorithms to quantify the contribution of critical brain region features to model discrimination.

A total of 356 sets of T1-weighted structural MRI data were enrolled from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. All samples were stratified and randomly divided into a training set containing 237 subjects [119 mild cognitive impairment converters (MCIc) and 118 mild cognitive impairment non-converters (MCInc)] and an independent test set consisting of 119 subjects (60 MCIc and 59 MCInc). Five-fold cross-validation was conducted on the training set to evaluate model stability. FreeSurfer v7.4.1 software was used to extract 1,481 brain structural features for constructing the feature matrix. Boruta nonlinear wrapper feature selection was performed, and 17 core features were retained ultimately. Four models, including support vector machine (SVM), extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM) and tabular prior-data fitted network (TabPFN), were constructed using the original and filtered feature sets separately. Logistic regression combined with LASSO regression (LR+LASSO) was introduced as a classic linear baseline for comparative analysis. SHapley Additive exPlanations (SHAP) was further applied to interpret brain region features associated with high conversion risk.

After Boruta feature screening, the separability of samples in the principal component space was improved substantially. The 17 retained features mainly involve brain regions such as the hippocampus, amygdala, temporal lobe and parietal lobe. On the independent test set, the Boruta+TabPFN pipeline achieved an accuracy of 0.765, an area under curve (AUC) of 0.823 and a false negative rate (FNR) of 0.200. Compared with LR+LASSO, Boruta+TabPFN achieved better performance in accuracy, precision, specificity and AUC. However, LR+LASSO yielded slightly higher recall at the target recall threshold, indicating that the linear baseline model prioritizes high sensitivity at the expense of specificity.

Effective nonlinear feature screening is required to build robust discriminative models with high-dimensional structural MRI features. Although Boruta+TabPFN did not obtain the optimal value for every single evaluation metric, it delivered steady performance in AUC, recall and false negative control, which better satisfies the clinical requirement of identifying high-risk individuals in the early screening of MCI-to-AD conversion. SHAP interpretability analysis demonstrated that the risk of MCI progression to AD is driven by coordinated morphological changes across multiple brain regions including the hippocampus, amygdala, temporal lobe, parietal lobe and limbic system, providing interpretable imaging evidence for early disease risk evaluation.