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Objective To investigate the impact of total parathyroidectomy with autotransplantation (tPTx+AT) on bone mineral density and serum soluble Klotho (sKlotho) level in patients with secondary hyperparathyroidism (SHPT). Methods A total of 86 patients undergoing tPTx+AT in the Second Affiliated Hospital of Anhui Medical University from June 2019 to May 2022 were recruited in this study. Their demographic characteristics were collected before surgery, along with serum levels of corrected calcium, phosphorus, intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), fibroblast growth factor 23 (FGF23), and sKlotho before and at 5 d, and 1, 3, 6, 12 and 24 months after surgery. Dual energy X-ray absorptiometry was used to determine the BMD values of the lumbar spine L1-L4 before surgery and at 3, 6, 12 and 24 months after surgery. The changes in BMD and serum FGF23 and sKlotho levels before and after tPTx+AT were observed. Results Surgical treatment was successfully completed in all 86 patients, with their clinical symptoms such as bone pain and skin itching significantly improved postoperatively, and markedly decreased serum calcium, phosphorus, iPTH, ALP and FGF23 levels. The sKlotho level was significantly lower at 5 d postoperatively than that preoperatively, with that at 1 month after surgery increased by approximately 24.5% than the preoperative level, and then the level was in a stable trend. The BMD values at the lumbar spine L1-L4 were increased postoperatively, and reached the highest levels at 12 months postoperatively. Further analyses showed that dialysis vintage, duration of SHPT, and ALP, iPTH and FGF23 levels were negatively correlated with the Z-scores of the lumbar spine L1-L4, while sKlotho level was positively correlated with the Z-scores. Conclusion tPTx+AT can significantly improve the clinical symptoms of SHPT patients, regulate the balance of calcium and phosphorus metabolism, increase sKlotho level and reduce FGF23 level. It is an effective method to improve BMD.

Online adaptive radiotherapy(OART)is considered to be a revolutionary technology after intensity-modulated radiotherapy. The first Chinese OART platform based on iterative cone beam computed tomography (iCBCT)has been applied in clinical treatment in Peking Union Medical College Hospital. This article reports the workflow and efficacy of first case with cervical cancer who received radical OART. After treatment, the patient achieved clinical complete remission with only a grade 1 radiation toxicity in the lower gastrointestinal tract. This article analyzes and discusses the clinical treatment process and follow-up data of this patient, aiming to provide clinical evidence for the subsequent large-scale application of artificial intelligence-driven iCBCT-guided OART technology.

Background: Image guidance is recommended for patients undergoing intensity‐modulated radiation therapy (IMRT) for cervical cancer. In this study, we evaluated the feasibility of a weekly image guidance pattern and analyzed the long‐term outcomes in a large cohort of patients. Methods: The study enrolled patients with Stage IB‐IVA cervical cancer who received definitive radiotherapy or concurrent chemoradiotherapy. IMRT was delivered at a dose of 50.4 Gy in 28 fractions, with weekly cone‐beam computed tomography (CBCT). Physicians advised patients on rectum and bladder preparation to help them prepare on nonimaging guidance days. When significant tumor regression was observed, a second computed tomography simulation and replanning were performed. Results: The median follow‐up periods were 63.4 months. The incidence rates of loco‐regional and distant failure were 9.9% and 13.6%. The 5‐year overall survival (OS), disease‐free survival (DFS), loco‐regional relapse‐free survival (LRFS), and distant metastasis‐free survival (DMFS) rates were 80.1%, 72.9%, 78.3%, and 74.8%, respectively. For patients with different stages, the 5‐year OS, DFS, LRFS, and DMFS rates were statistically significant. For patients with and without positive regional lymph nodes, the 5‐year OS, DFS, LRFS, and DMFS rates were 64.5% and 86.0%, 56.8% and 78.8%, 62.7% and 84.3%, and 58.8% and 81.0%, respectively. Multivariate analysis showed that age, histology, tumor size, cancer stage, pretreatment squamous cell carcinoma antigen level, and para‐aortic metastatic lymph nodes were independent prognostic factors of OS. Fifty‐six (4.0%) patients experienced late Grade 3/4 chronic toxicities. Conclusions: IMRT with weekly CBCT is an acceptable image guidance strategy in countries with limited medical resources. [ABSTRACT FROM AUTHOR]

The omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) characterized by 30 mutations in its spike protein, has rapidly spread worldwide since November 2021, significantly exacerbating the ongoing COVID‐19 pandemic. In order to investigate the relationship between these mutations and the variant's high transmissibility, we conducted a systematic analysis of the mutational effect on spike–angiotensin‐converting enzyme‐2 (ACE2) interactions and explored the structural/energy correlation of key mutations, utilizing a reliable coarse‐grained model. Our study extended beyond the receptor‐binding domain (RBD) of spike trimer through comprehensive modeling of the full‐length spike trimer rather than just the RBD. Our free‐energy calculation revealed that the enhanced binding affinity between the spike protein and the ACE2 receptor is correlated with the increased structural stability of the isolated spike protein, thus explaining the omicron variant's heightened transmissibility. The conclusion was supported by our experimental analyses involving the expression and purification of the full‐length spike trimer. Furthermore, the energy decomposition analysis established those electrostatic interactions make major contributions to this effect. We categorized the mutations into four groups and established an analytical framework that can be employed in studying future mutations. Additionally, our calculations rationalized the reduced affinity of the omicron variant towards most available therapeutic neutralizing antibodies, when compared with the wild type. By providing concrete experimental data and offering a solid explanation, this study contributes to a better understanding of the relationship between theories and observations and lays the foundation for future investigations. [ABSTRACT FROM AUTHOR]