Ionization chamber arrays are inherently limited in spatial resolution, which can lead to the underdetection of potential clinical errors in particle therapy. The study aimed to validate the clinical efficacy of a multi-position dose merging approach, evaluating its capacity to enhance spatial resolution and improve error detection sensitivity relative to conventional single-isocentre quality assurance (QA) protocols. Dose distributions were measured using PTW 729 XDR and 1500 XDR ionization chamber arrays at three clinically relevant depths within the spread-out Bragg peak (SOBP) region. Two datasets were generated: a merged dataset formed by combining dose distributions acquired at the isocentre and at the 5‑mm detector shifts (lateral x‑axis shifts for the 729 XDR array and longitudinal y‑axis shifts for the 1500 XDR array), and a single-isocentre dataset. The translational accuracy of the treatment couch was verified using a laser alignment system and a graduated scale. Bland-Altman analysis was performed to quantify the agreement and relative bias (
Abstract Objective Tumor budding (TB) is a histopathological marker of aggressive behavior and poor prognosis in rectal cancer (RC), yet not reliably evaluated preoperatively. We assessed whether histogram features from amide proton transfer-weighted (APTw) imaging and apparent diffusion coefficient (ADC) maps could serve as noninvasive biomarkers for preoperative TB grade prediction. Materials and methods This retrospective study included 204 patients with RC from June 2023 to May 2025, divided into a training cohort (n = 133) and a validation cohort (n = 71) using a temporal split. All patients underwent preoperative APTw and diffusion-weighted imaging, and TB grade was determined histopathologically. Histogram features were extracted from whole-tumor volumes on APTw and ADC maps. Feature selection used a machine learning-based classifier, followed by univariate and multivariate logistic regression to identify independent predictors. SHapley Additive exPlanations (SHAP) were applied for interpretability, and a nomogram integrating histogram and clinical variables was constructed. Results Five key histogram features (ADC-90%, ADC-Minimum, ADC-Range, APTw-10%, and APTw-Median) were selected. The histogram model achieved areas under the curve (AUROCs) of 0.85 (95% confidence interval [CI]: 0.79–0.92) and 0.86 (95% CI: 0.78–0.95) in the training and validation cohorts. SHAP analysis identified ADC-90% and ADC-Minimum as the most influential predictors. The combined model with histogram and clinical factors showed improved performance, with AUROCs of 0.88 (95% CI: 0.82–0.94) and 0.87 (95% CI: 0.79–0.96). Conclusion APTw and ADC histogram features can independently predict TB grade in RC. The combined model, integrating both histogram and clinical features, further enhanced preoperative predictive accuracy. Relevance statement This study investigates the role of imaging biomarkers in the preoperative stratification of RC, with the potential to enhance clinical decision-making and improve patient outcomes by providing more accurate, noninvasive prognostic information. Key Points A histogram-based model using APTw and ADC maps can predict TB grade in RC preoperatively. A combined model integrating clinical factors and histogram features improves predictive accuracy. This interpretable, contrast-free method provides a practical tool for clinicians to personalize treatment planning. Graphical Abstract
BackgroundNurses in China's public hospitals face high-pressure environments and emotional labor, leading to professional fatigue, identity conflicts, and reduced work efficacy. These challenges impact job satisfaction and engagement. Despite these issues, job crafting mechanisms, which could help nurses reshape their work roles to improve job satisfaction and efficacy, and managerial interventions remain underexplored. This study investigates the key factors that influence how nurses proactively adjust their tasks, relationships, and work environments, aiming to enhance engagement, performance, and workforce retention.AimThis study explores key factors influencing nurses' job crafting in China through a multi-level qualitative approach.MethodsFrom 2023 to 2024, semi-structured interviews were conducted with 18 registered nurses at a tertiary public hospital in China. Data collection included literature review and research group discussions, while data analysis was conducted using grounded theory.Ethical considerationsThe study was approved by the Ethics Committee of Gansu Provincial Hospital (No. 2025-267). Informed consent was obtained from all participants, and confidentiality was strictly maintained throughout the research process.FindingsThree themes emerged: adaptability (including knowledge-action gaps, task preferences, and learned helplessness), organizational support (leadership styles, incentives, and resource access), and interpersonal relationships (team effectiveness and contextual dependence). These themes reflect multilevel factors influencing nurses' job crafting behaviors within clinical and organizational contexts.ConclusionNurses' job crafting is shaped by individual adaptability, value-driven decision-making, and organizational support, with leadership playing a mediating role. Aligning with Maslow's hierarchy, job crafting requires a localized framework integrating management innovation and Chinese strategic wisdom to enhance adaptability and job satisfaction.
Colorectal cancer is a highly lethal gastrointestinal tract malignancy whose pathogenesis and molecular drivers are not fully understood. This study focused on searching for genes that are differentially expressed in cancer versus normal mucosa, with the goal of identifying molecular patterns of expression that are mechanistically linked to colorectal cancer pathogenesis. We analyzed 585 colorectal cancer samples and 329 normal samples from the Gene Expression Omnibus database, creating a weighted gene coexpression network analysis across 24,069 genes. Through this approach, five modules associated with colorectal cancer were identified, which were enriched in MAPK signaling and cholesterol metabolism pathways. Using least absolute shrinkage and selection operator (LASSO) regression, we selected 13 hub genes [ABCB5, AOC1, ARHGAP44, CACNG3, dysbindin domain-containing protein 1 (DBNDD1), GAS7, GTF2IRD1, PRSS22, SCN4A, TTC22, DLX6, PDK4, and SLC13A2] from these modules. Survival analysis indicated that higher expression of DBNDD1 correlated with worse overall survival in patients with colorectal cancer. Machine learning validation confirmed the stability of these genetic markers. Experimental validation demonstrated increased levels of DBNDD1 and growth differentiation factor 15 (GDF15) in colorectal cancer, promoting constant NF-κB (RELA) activation via DBNDD1-dependent GDF15 induction. Knocking down DBNDD1 inhibited cell proliferation, migration, and invasion in vitro (DLD1/HCT116 cells), alongside decreased GDF15 expression and reduced p-NF-κB p65-p-I-κB signaling. Additionally, DBNDD1 knockdown resulted in reduced tumor growth in vivo, highlighting that the DBNDD1-GDF15-NF-κB signaling pathway drives colorectal cancer pathogenesis. IMPLICATIONS:This study highlights the crucial role of the DBNDD1-GDF15-NF-κB signaling pathway in colorectal cancer development, positioning DBNDD1 as a promising target for precision medicine strategies aimed at enhancing patient outcomes.
Lavender essential oil (LEO), extracted from the flowers and upper parts of the lavender plant, has attracted considerable interest in the field of aromatherapy due to its anxiolytic, antidepressant, and hypnotic properties. However, the mechanisms underlying these effects of LEO remain inadequately elucidated, presenting challenges for its clinical application and promotion. This review aims to systematically analyze existing studies from a biological perspective to clarify the role and potential mechanisms of LEO in the contexts of anxiety, depression, and insomnia. The findings indicate that LEO exhibits anxiolytic effects by enhancing GABA receptor binding, increasing serotonin levels in the synaptic cleft, inhibiting glutamate release and its receptor interactions, and suppressing acetylcholine release at the neuromuscular junction. The antidepressant properties of LEO are attributed to its promotion of neurogenesis in the hippocampus, inhibition of inflammatory responses, and exertion of antioxidant effects. Furthermore, LEO has been demonstrated to possess hypnotic effects by elevating levels of melatonin and serotonin, reducing c-Fos expression in the prefrontal cortex, ventral hippocampus, and amygdala, and modulating GABAergic neurons in the central amygdala. These findings contribute to a deeper understanding of the biological effects of LEO and provide a substantial theoretical foundation for its clinical application.
