Rectal toxicity prediction based on accurate rectal surface dose summation for cervical cancer radiotherapy / 南方医科大学学报

<p><b>OBJECTIVE</b>To propose arectal toxicity prediction method based on deformable surface dose accumulation.</p><p><b>METHODS</b>The clinical data were collected retrospectively from 42patients receiving radiotherapy for cervical cancer. With the first fraction as the reference, the other fractions of rectum surface were registered to the reference fraction to obtain the deformation vector fields (DVFs), which were used to deform and sum the fractional rectal doses to yield the cumulative rectal dose. The cumulative rectal dose was flattened via 3D-2D mapping to generate a 2D rectum surface dose map. Two dosimetric features, namely DVPs and DGPs were extracted. Logistic regression embedded with sequential forward feature selection was used as the prediction model. The predictive performance was evaluated in terms of the accuracy, sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC).</p><p><b>RESULTS</b>Significant improvements for rectum surface DIR were achieved. The best predictive results were achieved by using both DVPs and DGPs as the features with a sensitivity of 79.5%, a specificity of 81.3% and an AUC of 0.88.</p><p><b>CONCLUSION</b>The proposed method is feasible for predicting clinical rectal toxicity in patients undergoing radiotherapy for cervical cancer.</p>

Systems biology is a bridge of integrated traditional Chinese and Western medicine / 中国中西医结合杂志

The integration of Chinese medicine (CM) and Western medicine (WM) is the only way for the development of medicine, and it is the best form for unifying systems theory and reductionism. In this paper, systems biology and its application in medical research were discussed. The authors put forward that systems biology may possibly interpret the scientific connotation of the complex theoretic systems of CM, which will make WM to well know the human body and disease. We hold that systems biology is a bridge of integrated CM and WM.

Cervical spinal canal narrowing and cervical neurological injuries / 中华创伤杂志(英文版)

Cervical spinal canal narrowing can lead to injury of the spinal cord and neurological symptoms including neck pain, headache, weakness and parasthesisas. According to previous and recent clinical researches, we investigated the geometric parameters of normal cervical spinal canal including the sagittal and transverse diameters as well as Torg ratio. The mean sagittal diameter of cervical spinal canal at C(1) to C(7) ranges from 15.33 mm to 20.46 mm, the mean transverse diameter at the same levels ranges from 24.45 mm to 27.00 mm and the mean value of Torg ratio is 0.96. With respect to narrow cervical spinal canal, the following charaterstics are found: firstly, extension of the cervical spine results in statistically significant stenosis as compared with the flexed or neutral positions; secondly, females sustain cervical spinal canal narrowing more easily than males; finally, the consistent narrowest cervical canal level is at C(4) for all ethnicity, but there is a slight variation in the sagittal diameter of cervical spinal stenosis (less than or equal to 14 mm in Whites, less than or equal to 12 mm in Japanese, less than or equal to 13.7 mm in Chinese). Narrow sagittal cervical canal diameter brings about an increased risk of neurological injuries in traumatic, degenerative and inflammatory conditions and is related with extension of cervical spine, gender, as well as ethnicity. It is hoped that this review will be helpful in diagnosing spinal cord and neurological injuries with the geometric parameters of cervical spine in the future.

Influence of degenerative changes of intervertebral disc on its material properties and pathology / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the material properties of normal and degenerated intervertebral discs (IVDs) and examine the effect of degenerative changes on IVD pathology.</p><p><b>METHODS</b>A computer-based online search was undertaken to identify English articles about material properties of IVDs published from January 1950 to 2011 in PubMed database. The retrieved keywords included material properties, intervertebral disc and degeneration. Based on the principles of reliability, advancement and efficiency, the obtained data were primarily examined, and the original source was retrieved to read the full-text. Repetitive articles were excluded. The data of material properties of normal and degenerated IVDs were summarized and analyzed by meta-analysis.</p><p><b>RESULTS</b>The data of Young's modulus, Poisson's ratio, shear modulus, hydraulic permeability and intradiscal pressure of normal and degenerated IVDs were obtained. Compared with normal IVDs, the Young's modulus and shear modulus of annulus fibrosus and nucleus pulposus were higher in degenerated IVDs, the Poisson's ratio was lower while the hydraulic permeability and intradiscal pressure were higher. Besides, the degeneration-related alterations in IVDs had an influence both on itself and other spinal structures, leading to diseases such as bulging disc, discogenic pain and spinal stenosis. Meanwhile, the heavy mechanical loading and injury indicated important pathways to IVD degeneration.</p><p><b>CONCLUSIONS</b>To a certain extent, the degenerative changes of IVD influence its material properties. And the degeneration-related alterations of composition can cause structural failure of IVDs, leading to injuries and diseases.</p>

The application of metabonomics in modern studies of Chinese materia medica / 中国中西医结合杂志

Metabonomics, a newly developing subject secondary to genomics, transcriptomics, and proteomics, is an important constituent part of systems biology. It is believed to be the final direction of the systems biology. It can be directly applied to understand the physiological and biochemical states by its "metabolome profile" as a whole. Therefore, it can provide a huge amount of information different from those originating from other "omics". In the modernization of Chinese materia medica research, the application of metabonomics methods and technologies has a broad potential for future development. Especially it is of important theoretical significance and application value in holistic efficacies evaluation, active ingredients studies, and safety research of Chinese materia medica.

Proteomics is the important technology platform of Chinese medicine pathogenesis research / 中国中西医结合杂志

Pathogenesis is the core of the theoretical system in Chinese medicine (CM). Pathogenesis research is the breakthrough of the innovation and development of CM theories. Proteomics and CM pathogenesis were amazingly similar in aspects of integrity, dynamics, space, and complexity. It is of great significance using proteomics methods in studying CM pathogenesis essence and evolution laws, exploring the mechanisms of classical prescriptions or recipes with therapeutic efficacy, and promoting the modernization of CM.

Effects of low level manganese exposure on the serum neuroendocrine hormones in the welders / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To study the effects of low level manganese (Mn) exposure on the serum neuroendocrine hormones levels of the welders.</p><p><b>METHODS</b>The exposure group consisted of 41 male welders, 40 male workers without exposing to harmful agents served as controls. The serum contents of prolactin (PRL), luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (TST) and thyroid stimulating hormone (TSH) of 81 subjects were detected by chemiluminescence immunoassay.</p><p><b>RESULTS</b>The geometric mean value of airborne Mn concentrations was 0.03 mg/m(3) (0.003 - 0.519 mg/m(3)) in the welding circumstances. The levels of Mn in red blood cells (RBCs) and urinary Mn of the exposure group were significantly higher than those of control group (P < 0.01). The contents of serum LH and TSH of the exposure group were 2.89 ± 0.69 mIU/ml and 1.45 ± 0.56 uIU/ml, which were significantly lower than those (3.82 ± 1.61 mIU/ml and 2.19 ± 1.28 µIU/ml) of control group (P < 0.01). The serum contents of LH, FSH and TSH of the group exposed to Mn for < 5 years were significantly lower than those of the control group, The serum TST level of the group exposed to Mn for < 5 years was significantly higher than those of the control group and group exposed to Mn for 5 ∼ years, the serum FSH level of the group exposed to Mn for < 5 years was significantly lower than that of the group exposed to Mn for 10 years (P < 0.05 or P < 0.01). The serum contents of LH and TSH of the group exposed to Mn for 5 ∼ years were significantly lower than those of the control group (P < 0.05 or P < 0.01). The serum contents of PRL, LH and TSH of the group exposed to Mn for 10 years were significantly lower than those of the control group (P < 0.05). There was negative correlation between blood (RBC) Mn and urinary Mn (r = -0.310, P < 0.05), also there was negative correlation between serum PRL and serum TST (r = -0.409, P < 0.01), the positive correlation between serum LH and serum FSH was observed (r = 0.361, P < 0.05).</p><p><b>CONCLUSION</b>The results of present study showed that the long exposure to low level of Mn may decrease the levels of serum PRL, LH and TSH in workers occupationally exposed to Mn, which can influence the metabolism of neuroendocrine hormones to certain extent.</p>

Experimental study on calibration system of side-impact dummy neck / 医用生物力学

Objective To investigate the design approaches and manufacturing techniques for the calibration system of side impact dummy neck. Method The ES-2 side impact dummy neck was selected as the research subject and a set of calibration system of ES 2 side impact dummy neck was developed in this experiment according to the pendulum impact theory, and the new design approaches and new manufacturing techniques suitable for the present industrial conditions in China were created to establish its two key components: the pendulum device and the head-neck flexion angle measurement device. The optimal designs for the quality distribution and inertia moment distribution of the whole pendulum were also carried out to assure the pendulum initial velocity and the pendulum impact velocity time curve during the pendulum absorber impact, while optimal designs for three angle sensors and the complex stereoscopically dependent relationship among those three sensors were carried out to assure the reliability of the head neck flexion angle measurement device. Correspondingly, a total of six calibration tests were carried out to validate this calibration system in terms of the technical requirements of ECE R95. Results The pendulum initial velocity of 3.36～3.48 m/s and the pendulum impact velocity time curve during the pendulum absorber impact, which were generated by the pendulum device in this calibration system of ES 2 side impact dummy neck, were in accordance with the ECE R95. Meanwhile, the head neck flexion angle measurement device of this calibration system was sufficient to detect the following three target angle values more accurately: the maximum values of fore pendulum base angles, the maximum values of aft pendulum base angles, and the maximum values of head neck complex flexion angles. Conclusions The calibration system of ES-2 side impact dummy neck is basically capable of meeting the demands of the existing international rule, the ECE R95. Besides, this neck calibration system is convenient and practical, and its design approaches and manufacturing techniques are likely to find the wider application in the impact biomechanics field.

The effect of 131I on apoptosis of thyrocytes in patients with Graves disease / 中华核医学杂志

Objective To investigate the effect of 131I on apoptosis of thyrocytes in patients with Graves disease. Methods Forty-seven patients with Graves disease were divided into two groups, two week group (G2w) and four week group (G4w). All patients underwent thyoid needle biopsy before 131I treatment and the repeated biopsy at two weeks (G2w) or four weeks (G4w) after 131I treatment. The positive units of pro-apoptotic proteins (Fas, FasL) and anti-apoptotic protein (Bcl-2) were studied with immunohistochemistry staining. The differences of the two groups were compared with t-test. Liner correlation analysis was applied to study the correlation between 131I dose and apoptosis-related proteins and that between serum sTSH after 131I treatment and apoptosis-related proteins. Results Fas, FasL and Bcl-2 expression (positive units) were significantly increased in both groups after 131I treatment, G2w :22.84 ± 9.31 vs 16.20 ± 6.75,21.13±6.29vs 14.56±4.06, 21.69±7.83 vs 15.22 ±5.94, t= -3.08, -3.73, -4.05 (allP<0.05); G4w:21.69 ±4.52 vs 15.83 ±5.03, 19. 11 ±3.75 vs 14.02 ±4.98, 19.06 ±3.44 vs 16.63 ±4. 73, t = - 5.26, - 5.00, - 2.41 (all P<0.05). However, no statistical differences were found between G2w and G4w (t = 0. 53, 0. 82, 1.46, all P > 0.05). Significant correlation was found between 131I 0. 727, rFasL = 0. 763 (both P<0.05)), but not between the dose and Bcl-2, rBcl-2 = - 0. 094, 0. 102(both P > 0.05). There were significant correlation between serum sTSH three months after 131I treatment and apoptosis-related proteins, rFas = 0.433, rFasL = 0. 601, rBcln2 = - 0. 397, (all P<0. 05). Conclusions 131I can induce thyrocytes to express the pro-apoptotic proteins in patients with Graves disease.

Viewing from the toll-like receptor/nuclear factor-kappaB signaling pathway to explore the immunomodulatory mechanism of Chinese drugs / 中国中西医结合杂志

Many Chinese drugs (CHD) have showed their significant effects of integral immune-regulation, and lots of researches have conducted in recent years for exploring their mechanism from different levels, like cytological, molecular and genetic levels. In this paper, the relation between immune-regulation of CHD and Toll-like receptors/nuclear factor-kappaB (TLRs/NF-kappaB) signaling pathway was introduced in brief based upon the achievements of previous researches. It was pointed out that the two are closely related, to explore mechanism of CHD in this way is meaningful not only for further deepening the theoretical understanding of CHD's pharmacological immunoregulation, but also be practically facilitate for enhancing therapeutic efficacy of CHD and developing new CHD.

Establishment of the model of motorcyclist ejection injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To establish the device and model of motorcyclist ejection injury.</p><p><b>METHODS</b>Based on our laboratory devices, a motorcyclist ejection injury simulation system was developed. A total of 18 pigs were approved by the local animal experimentation and ethics committee to serve as the motorcyclist substitutes. In this ejection motion, the animal rode freely at the motor driver seat and was straightly accelerated by means of our custom motorcyclist ejection injury simulation system. When it was speeded up to the preset velocity (v equal to 30, 40 or 50 km/h) at the preset position, the animal was ejected forward. Pathological and dynamic analyses were conducted, accompanied with the high-speed photograph, acceleration/velocity signal test, gross observation and light microscope examination as well as the abbreviated injury score-injury severity score (AIS-ISS) scale.</p><p><b>RESULTS</b>The high-speed photograph indicated that during the ejection procedure the motorcycle was first arrested and decelerated suddenly, and then the motorcycle driver was ejected forward, accompanied with the rotation motion in the air. Finally, the head, shoulder and thorax of the ejected animal impacted directly on the hard ground. Varying degrees of injury focusing on the liver, heart, lung and spleen were found. There existed a significant positive correlation between ISS and the ejection velocity of the motorcycle drivers (ISS equal to 16.7+/-2.9 for 30 km/h, 25.0+/-0.0 for 40 km/h and 37.3+/-1.0 for 50 km/h). The detailed injury characteristics were as follows: for the mildly injured animals, there were interlobar gaps or leaf gaps and lobar surface blood coagulation blocks in the liver, and mild lung hemorrhage; for the severely injured animals, there were liver comminuted laceration, moderate lung hemorrhage and heart injury. Animals suffering from the most severe injuries died half an hour later.</p><p><b>CONCLUSION</b>The new injury model stated in this paper has a high stability and good repeatability, and is likely to be helpful to deeply investigate the injury mechanisms and protection countermeasures of motorcyclist ejection injury.</p>

X-ray observation on how axial compression stimulates tibial fracture healing / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To validate the hypothesis that there exists an optimal axial compression stress range to enhance tibial fracture healing.</p><p><b>METHODS</b>Rabbits with a surgically induced V-shaped tibial fracture were separated into 2 main groups: the control group (C Group, n equal to 6) without application of any axial compression stress stimulation postoperatively and the stimulation group (S Group, n equal to 90). The S Group was further divided into 20 subgroups (S11 to S54) in terms of 5 axial compression stress stimulation levels (112.8 kPa, 289.8 kPa, 396.5 kPa, 472.7 kPa, and 602.3 kPa) and 4 experimental endpoints (1, 3, 5 and 8 weeks after operation). A custom made circular external fixator was used to provide the axial compression stress of the fracture sites. Based on X-ray observation, a fracture healing scoring system was created to evaluate the fracture healing process.</p><p><b>RESULTS</b>At 8 weeks after operation, there existed a "arch shape" relationship between healing score and axial compression stress stimulation level of fracture site. The optimal axial compression stress stimulation ranged from 289.8 kPa to 472.7 kPa, accompanying the best fracture healing, i.e. the fracture line became indistinct or almost disappeared, and a lot of callus jointed the two fracture ends. Meanwhile, at 5 weeks after operation, corresponding to the relatively low healing scores, there was a fracture healing performance similar to that at 8 weeks. Besides, at 1 or 3 weeks after operation, for all the axial compression stress levels (0-602.3 kPa), no obvious healing effect was found.</p><p><b>CONCLUSIONS</b>It is implied from the stated X-ray observation results in this study that the potential optimal axial compression stress stimulation and optimal fracture healing time are available. The axial compression stress level of 289.8-472.7 kPa and fracture healing time of more than 8 weeks jointly comprise the optimal axial compression stress stimulation conditions to enhance tibial fracture healing.</p>

Variations of brain magnetic resonance imaging among manganese-exposed workers / 中华预防医学杂志

<p><b>OBJECTIVE</b>Variations of the signal intensities in the magnetic resonance (MR) T(1)-weighted image (T(1)WI) of globus pallidus among manganese(Mn)-exposed workers were explored to provide a scientific basis for exposed biomarker of manganese-injured central nervous system (CNS).</p><p><b>METHODS</b>The brain MR T(1) and T(2) WI in eighteen male asymptomatic Mn-exposed, eight manganism and nine healthy control workers were examined routinely by adopting a 1.5 Tesla signal superconducting system. The SIGP and the signal intensity in frontal white matter (SIFWM) in the same side were determined, then pallidal index (PI) was calculated. Concentration of MnO(2) in workplaces and content of manganese in red blood cell (MnRBC) among workers were respectively determined by flame atomic absorption spectrometer (AAS) and inductively coupled plasma-atomic emission spectrophotometry (ICP-AES). The follow-up investigation in the eight high Mn-exposed workers was made one year later.</p><p><b>RESULTS</b>The results showed that the median of air MnO(2) in smelting workplace was 0.64 mg/m(3)(0.07 - 5.40 mg/m(3)), which were respective 0.56 mg/m(3)(0.09 - 1.71 mg/m(3)) in power distribution room (low Mn-exposure) and 0.89 mg/m(3) (0.07 - 5.40 mg/m(3)) in furnace (high Mn-exposure). PI in the Mn-exposed and high Mn-exposed workers were both higher than those of the manganism and control workers(116.4 +/- 8.2, 119.0 +/- 7.9, 105.3 +/- 8.4 and 102.2 +/- 1.5, respectively. Mn vs control, t' = 7.146, P = 0.000; Mn vs manganism, t = 3.181, P = 0.004. High Mn-exposure vs control, t' = 7.446, P = 0.000; high Mn-exposure vs manganism, t = 3.763, P = 0.001). The increased signal in T(1)WI of globus pallidus was observed in Mn-exposed workers, especially in high Mn-exposed workers. The content of manganese in red blood cell of Mn-exposed and control workers was significantly higher than those of the manganism workers [(151.6 +/- 40.5) ng/ml, (149.2 +/- 21.3) ng/ml, (154.5 +/- 46.6) ng/ml, (144.4 +/- 14.2) ng/ml, (20.8 +/- 7.4) ng/ml respectively. The difference was significant in statistics. Manganism vs control, t = 20.206, P = 0.000; manganism vs Mn, t' = 13.144, P = 0.000; manganism vs low and high Mn, t' = 12.964, 9.957, respectively, P = 0.000]. Only a decreased median of air MnO(2) in furnace was found one year later (0.89, 0.31 mg/m(3), Z = -2.142, P = 0.032). The difference was significant in statistics.</p><p><b>CONCLUSION</b>Our data suggests that SIGP of MR T(1)WI among workers was obviously increased by manganese-exposure. PI may be taken as the signal of CNS injury which was induced by manganese-exposure.</p>

Biomechanics of whiplash injury / 中华创伤杂志(英文版)

Despite a large number of rear-end collisions on the road and a high frequency of whiplash injuries reported, the mechanism of whiplash injuries is not completely understood. One of the reasons is that the injury is not necessarily accompanied by obvious tissue damage detectable by X-ray or MRI. An extensive series of biomechanics studies, including injury epidemiology, neck kinematics, facet capsule ligament mechanics, injury mechanisms and injury criteria, were undertaken to help elucidate these whiplash injury mechanisms and gain a better understanding of cervical facet pain. These studies provide the following evidences to help explain the mechanisms of the whiplash injury: (1) Whiplash injuries are generally considered to be a soft tissue injury of the neck with symptoms such as neck pain and stiffness, shoulder weakness, dizziness, headache and memory loss, etc. (2) Based on kinematical studies on the cadaver and volunteers, there are three distinct periods that have the potential to cause injury to the neck. In the first stage, flexural deformation of the neck is observed along with a loss of cervical lordosis; in the second stage, the cervical spine assumes an S-shaped curve as the lower vertebrae begin to extend and gradually cause the upper vertebrae to extend; during the final stage, the entire neck is extended due to the extension moments at both ends. (3) The in vivo environment afforded by rodent models of injury offers particular utility for linking mechanics, nociception and behavioral outcomes. Experimental findings have examined strains across the facet joint as a mechanism of whiplash injury, and suggested a capsular strain threshold or a vertebral distraction threshold for whiplash-related injury, potentially producing neck pain. (4) Injuries to the facet capsule region of the neck are a major source of post-crash pain. There are several hypotheses on how whiplash-associated injury may occur and three of these injuries are related to strains within the facet capsule connected with events early in the impact. (5) There are several possible injury criteria to correlate with the duration of symptoms during reconstructions of actual crashes. These results form the biomechanical basis for a hypothesis that the facet joint capsule is a source of neck pain and that the pain may arise from large strains in the joint capsule that will cause pain receptors to fire.

Comparative observation of protective effects of earplug and barrel on auditory organs of guinea pigs exposed to experimental blast underpressure / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore the protective effects of earplug and barrel on auditory organs of guinea pigs exposed to experimental blast underpressure (BUP).</p><p><b>METHODS</b>The hearing thresholds of the guinea pigs were assessed with auditory brainstem responses (ABR). The traumatic levels of tympanic membrane and ossicular chain were observed under stereo-microscope. The rate of outer hair cells (OHCs) loss was analyzed using a light microscope. The changes of guinea pigs protected with barrel and earplug were compared with those of the control group without any protection.</p><p><b>RESULTS</b>An important ABR threshold shift of the guinea pigs without any protection was detected from 8h to 14d after being exposed to BUP with a peak ranging from -64.5 kPa to -69.3 kPa ( P<0.01). The rate of perforation of tympanic membrane reached 87.5% and that of total OHCs loss was 19.46% +/- 5.38% at 14d after exposure. The guinea pigs protected with barrel and earplug had lower ABR threshold and total OHCs loss rate compared with the animals without any protection (P<0.01). All of the tympanic membrane and ossicular chain of the protected animals maintained their integrities. Meanwhile, the guinea pigs protected with the barrel had lower ABR threshold and total OHCs loss rate than those with earplug (P<0.01).</p><p><b>CONCLUSIONS</b>The earplug and barrel have protective effects against BUP-induced trauma on auditory organs of the guinea pigs and the protective effects of barrel are better than those of earplug.</p>

Study on trauma of tympanic membrane and ossicular chain of guinea pigs exposed to experimental blast underpressure / 中华创伤杂志

Objective To probe into the characteristics of traumatic effect of blast underpressure (BUP) on tympanic membrane and ossicular chain of guinea pigs exposed to blast underpressure. Methods The guinea pigs were exposed to experimental BUP generated by the underpressure generator and their tympanic membranes and auditory ossicules were observed with stereo-microscope.Results Most of the tympanic membranes in 72 guinea pigs (141 ears) presented with traumatic changes,such as engorgement,haemorrhage,epidermic desquamation and perforation,combined with fracture of ossicles in some guinea pigs.The traumatic severity of the tympanic membranes and auditory ossicules was related to the peak and the declinating duration of BUP.The minimum peak of the underpressure inducing perfo- ration was between-22.4kPa and-23.9kPa and the minimum peak inducing perforation of all the tym- panic membranes was between-83.1kPa and-87.2kPa.Conclusion The tympanic membrane in guinea pigs exposed to BUP changed traumatically,such as engorgement,haemorrhage,epidermic des- quamation,perforation and fracture of ossicles.The traumatic severity of the tympanic membranes and au- ditory ossicules is related to the peak and declinating duration of BUP.