Establishment of risk prediction model for postoperative liver injury after non-liver surgery based on different machine learning algorithms / 陆军军医大学学报

Objective To construct a machine learning prediction model for postoperative liver injury in patients with non-liver surgery based on preoperative and intraoperative medication indicators.Methods A case-control study was conducted on 315 patients with liver injury after non-liver surgery selected from the databases developed by 3 large general hospitals from January 2014 to September 2022.With the positive/negative ratio of 1 ∶3,928 cases in corresponding period with non-liver surgery and without liver injury were randomly matched as negative control cases.These 1243 patients were randomly divided into the modeling group(n=869)and the validation group(n=374)in a ratio of 7∶3 using the R language setting code.Preoperative clinical indicators(basic information,medical history,relevant scale score,surgical information and results of laboratory tests)and intraoperative medication were used to construct the prediction model for liver injury after non-liver surgery based on 4 machine learning algorithms,k-nearest neighbor(KNN),support vector machine linear(SVM),logic regression(LR)and extreme gradient boosting(XGBoost).In the validation group,receiver operating characteristic(ROC)curve,precision-recall curve(P-R),decision curve analysis(DCA)curve,Kappa value,sensitivity,specificity,Brier score,and F1 score were applied to evaluate the efficacy of model.Results The model established by 4 machine learning algorithms to predict postoperative liver injury after non-liver surgery was optimal using the XGBoost algorithm.The area under the receiver operating characteristic curve(AUROC)was 0.916(95%CI:0.883～0.949),area under the precision-recall curve(AUPRC)was 0.841,Brier score was 0.097,and sensitivity and specificity was 78.95%and 87.10%,respectively.Conclusion The postoperative liver injury prediction model for non-liver surgery based on the XGBoost algorithm has effective prediction for the occurrence of postoperative liver injury.

Reference values for inspiratory muscle related indexes of preschool children in Nanjing / 中国儿童保健杂志

【Objective】 To generate reference values for inspiratory muscle of preschool children in Nanjing, so as to provide a reference index for evaluating children′s lung function and exercise performance. 【Methods】 A total of 236 preschool children were selected from the main urban area of Nanjing by stratified cluster sampling.The inspiratory muscles were evaluated by breath link respiratory function evaluation system to obtain the maximum inspiratory pressure (MIP) and inspiratory peak flow rate.Pearson analysis was used to determine the correlation of MIP and inspiratory peak flow rate with gender, age, height and weight.Multiple linear stepwise regression analysis was used to obtain the formula of MIP and inspiratory peak flow rate. 【Results】 Differences in MIP and peak inspiratory flow rate were not significant between boys and girls (P>0.05), but were statistically significant among different age groups and showed an increasing trend with age (F=13.660, 33.581, P<0.001).MIP and peak inspiratory flow rate were positively correlated with children′s age, height and weight (P<0.001).The regression model, proved to be statistically significant(F=12.913、22.398, P<0.08), indicated that height was the best predictor of MIP and age was the best predictor of inspiratory peak flow rate. 【Conclusions】 This study is the first study on the predicted value of inspiratory muscle in preschool children in China.The predicted value formula can provide a reference for clinical inspiratory muscle evaluation.

Research on Logic Design of Proton Treatment Control System / 中国医疗器械杂志

The proton treatment control system is the supporting software of the proton therapy device, which specifically coordinates and controls the status and work of each subsystem. In this study, the software architecture and hardware implementation of the proton treatment control system was developed and built a foundation for the overall debugging. Using C# programming language and WPF programming techniques, TCP network communication protocol specified by the proton treatment technical document and MVVM pattern in Windows system, the logic design and implementation of each level were studied. Meanwhile, the communication interface between the subsystems under TCP communication protocol was agreed. The logic design and research of the setup field and treatment field were carried out. And the User Interface was designed and developed using the above technology. The program realizes the communication and interaction between the proton treatment control system and each subsystem, so as to control and monitor the whole treatment process. The proton treatment control system provides a software basis for the remote overall debugging and on-line monitor and control of proton treatment device.

Retrospective cohort study on the efficacy of methotrexate combined with mifepristone in the treatment of ectopic pregnancy / 中国药房

OBJECTIVE To investigate the efficacy of Methotrexate （MTX） injection combined with Mifepristone tablets in the treatment of ectopic pregnancy. METHODS A retrospective cohort study method was used to collect data on patients with ectopic pregnancy who visited the Affiliated Hospital of Chengdu University from January 1， 2013 to December 31， 2021. Control group was given MTX injection alone， and exposure group was given MTX injection combined with Mifepristone tablets. Baseline variables were balanced between the two groups using a propensity score matching （PSM）， and the outcomes of the matched cohorts were compared. RESULTS A total of 125 patients were included， involving 68 in the control group and 57 in the exposure group. After PSM， 46 cases in each group were successfully matched. There was no significant difference in the treatment response rate and the incidence of adverse drug reaction （ADR） between the exposure group and the control group， which were 73.91% and 63.04%， 21.74% and 13.04% （P＞0.05）. Compared with before treatment， serum levels of β-HCG were all significantly decreased in 2 groups after treatment （P＜0.05）； there was no significant difference in the serum level of β-HCG after treatment， the time to return to normal， the interval time of second pregnancy， second ectopic pregnancy and second intrauterine pregnancy between 2 groups （P＞0.05）. The mean diameter difference of B-ultrasound pregnancy mass before and after treatment， duration of clinical symptom remission and length of hospital stay in the exposure group were significantly higher than those in the control group （P＜ 0.05）， but drug costs during hospitalization and total hospitalization costs were not significantly increased （P＞0.05）. There were no significant difference between single-dose group and multi-dose group of MTX in the treatment response rate and the incidence of ADR （P＞0.05）. The hospitalization time， drug cost and total cost of the single dose group were significantly less than those of the multi-dose group （P＜0.05）. CONCLUSIONS MTX injection combined with or without Mifepristone tablet can both effectively treat ectopic pregnancy， with comparable efficacy and safety. MTX single-dose regimen is similar to the multi-dose regimen in efficacy， but the multi-dose regimen increases the hospital stay and hospitalization costs.

Effect of couch rotation angle on non-coplanar static intensity-modulated radiotherapy plan for gastric cancer / 中国辐射卫生

Objective To investigate the effect of couch rotation angle on non-coplanar static intensity-modulated radiotherapy (IMRT) plan for gastric cancer and to provide a reference for clinical planning. Methods A retrospective analysis was conducted on patients who recently underwent postoperative IMRT for gastric cancer. Twenty patients who received radiotherapy in the centre of Radiation Oncology of Huanggang Central Hospital from August 2022 to January 2023 were selected. That were selected to receive a seven-field coplanar static IMRT plan based on a couch rotation angle of 0° as the control group. Then, based on the coplanar IMRT plan, only the couch rotation angle of gantry angles 30° and 330° was changed to 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80°, and 90°, respectively, and nine different non-coplanar plans were established. The homogeneity index (HI), conformity index (CI) of the target volume, and monitor unit (MU), as well as Dmean, V20, and V30 of the left and right kidneys, Dmax, Dmean, V10, V20, and V30 of the spinal cord, and Dmax, Dmean, V10, V20, V30, and V40 of the small intestine and liver were compared among the 10 plans. The MU and the dosimetric parameters of the target volumes and When the couch rotation angle was 60°, the minimum HI and maximum CI of the target volume were 0.0714±0.0089 and 0.9271±0.0108, respectively, and the minimum MU was 438±26, with the best homogeneity and conformity in the target volume and the shortest machine treatment time (P＜0.05). When the couch rotation angle was 10°, the Dmax of the small intestine was lowest, being (4620.73±99.27) cGy. When the couch rotation angle was 60°, the Dmean of the left and right kidneys was lowest, being (1246.30±130.35) cGy and (1001.52±103.33) cGy, respectively; the V20 of the left and right kidneys was lowest, being 22.87±6.29 and 19.69±1.84, respectively; the V10 and V30 of the spinal cord were lowest, being 40.08±4.92 and 1.68±0.34, respectively (P＜0.05). Conclusion The couch rotation angle has some influence on the postoperative treatment planning for patients with gastric cancer. In the design of non-coplanar plan for gastric cancer, the couch rotation angle of 60° contributes to establishing a better radiotherapy plan.

Application of the second derivative-based small monitor unit beam deletion optimization to CyberKnife planning of heads / 中华放射医学与防护杂志

Objective:To investigate the effects of different small monitor unit (MU) beam deletion optimization method in the CyberKnife treatment planning system on the calculated planned dose to brain tumors.Methods:A total of 17 patients with brain metastases treated in our hospital from June, 2021 to February, 2022 were selected for this study. A treatment plan was designed for each patient using the multiPlan system in the CyberKnife VSI system as the group without optimization. To improve the efficiency, the generated original plans should be optimized first by deleting some small MUs, forming an experience group and an optimization group for each patient. For the experience group, beams below 30 MU were deleted according to experience. For the optimization group, beams below the MU value calculated based on the second derivative method were deleted. Finally, the parameters of the two groups were statistically compared. The main evaluation parameters included the node number, the beam number, the total number of MUs, the estimated treatment duration, doses to 2% and 95% planning target volumes (PTV D2 and PTV D95), average dose to PTV ( Dmean), average dose to brain tissue ( Dmean-Brain), conformity index (CI), new conformity index (nCI), gradient index (GI), coverage, and the maximum doses to the brainstem and left and right lens ( Dmax-BS, Dmax-LL, and Dmax-RL), and the average doses to the dose shells 20 mm and 40 mm away from PTV (Shell20 and Shell40). Results:The two optimization method met the requirements for the prescription dose delivery to more than 98% PTV. There were statistical differences in the node number ( H = 7.97, P< 0.05) and estimated treatment duration ( H = 6.60, P < 0.05) among the group without MP optimization, the experience group, and the optimization group, with the estimated treatment duration and node number of the optimization group less than those of the group without MP optimization ( P < 0.05). There were no statistically significant differences in other parameters among the three groups ( P > 0.05). The PTV was moderately positively correlated with the treatment duration ( r=0.79, P < 0.01) and beam number ( r=0.78, P < 0.01) of the experience group, and was also moderately positively correlated with the treatment duration ( r=0.69, P < 0.01) and beam number ( r=0.71, P < 0.01) of the optimization group. Conclusions:For the CyberKnife planning of heads, the small MU beam deletion optimization method based on the second derivative can further shorten the treatment duration while ensuring no significant differences in the distribution of doses to organs at risk and targets. Moreover, this method is more effective in optimizing the plans for a large PTV volume.

Dose reconstruction of volumetric modulated arc therapy for nasopharyngeal carcinoma based on log files and CBCT / 中华放射肿瘤学杂志

Objective:To reconstruct the dose of nasopharyngeal carcinoma and verify the results of the whole-process radiotherapy plan based on log files and cone beam CT (CBCT).Methods:A total of 15 patients with nasopharyngeal carcinoma who received volumetric modulated arc therapy (VMAT) with Halcyon accelerator in the Cancer Center of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from February to September 2022 were retrospectively selected. Log files and CBCT for all fractionated radiotherapy were recorded. The errors of monitor unit (MU), gantry angle, and multi-leaf collimator (MLC) leaf position per control point were analyzed. The adaptive CT (aCT) were generated according to CBCT and planned CT (pCT) using a commercial software Velocity TM, and the similarities among aCT, pCT and CBCT were analyzed. The original plan was modified from the log files and imported into the treatment planning system to calculate the delivered dose on the corresponding fractionated aCT to reconstruct the fractionated dose. And all the reconstructed doses were mapped back to pCT to obtain the cumulative dose. Theγpass ratios with criteria of 2 mm/2% and 2 mm/3% and the dose differences between the planned dose and the cumulative dose in the planning target volume (PTV) and organs at risk (OAR) were compared. Results:The root mean square (RMS) and the 95th percentile of the errors of MU, gantry angle and MLC leaf position errors were within an acceptable range. The aCT generated by Velocity TM had the anatomical structure of CBCT and the resolution, contrast, noise characteristics of pCT, which could be directly used for dose calculation. Compared with the planned dose, the changes of V 70 Gy of nasopharyngeal primary tumor (PTV nx), V 68 Gy of cervical glands (PTV nd) and V 60 Gy of planning target volume (PTV1) were -0.88%±1.91%, -2.99%±2.99% and -0.63%±0.93%, respectively, and V 40 Gy of parotid gland was increased to 2.65%±2.63%. Cumulative dose showed different degrees of PTV dose decrease ( P<0.05) and parotid dose was increased ( P<0.05). The γ pass ratio (2 mm/3%) between the cumulative dose and planned dose was 97.3%±2.7% and >95.0% in 86.7% of patients. Conclusions:Based on the log files and CBCT, the whole-process dose reconstruction of nasopharyngeal carcinoma patients can be carried out. According to the results of dose reconstruction, the radiotherapy effect of the target area and OAR can be quantitatively evaluated. In the case of high dose coverage and conformity of the original plan, the reconstruction results show that the cumulative dose coverage of the target area is decreased, whereas that of the parotid gland is increased.

Distribution differences of pathogenic bacteria among different populations with urinary system infection / 中国基层医药

Objective:To investigate the distribution difference of pathogens among various populations and to provide a basis for clinically rational drug use.Methods:The clinical data of 1 045 patients with urinary system infections who received treatment at the Affiliated Hospital of Chengdu University from July 2021 to June 2022 was collected. The distribution characteristics of pathogenic bacteria in different populations (different ages, different genders, and different concomitant diseases) were retrospectively analyzed.Results:A total of 1 045 specimens from 1 045 patients with urinary tract infection were included in the final analysis. Among them, 743 cases were gram bacteria-positive, 205 cases were gram bacteria-negative, and 97 cases were fungi-positive. A total of 625 cases were older (aged 65 years and above) adults, accounting for 59.81%. The proportion of urine fungi-positives in the older adult population [11.68% (73/625)] was twice that of urine fungi in the young and middle-aged population (< 65 years old) [5.17% (24/420)]. Among the positive results of urine culture, older adults with diabetes mellitus accounted for the highest proportion [20.96% (219/1 045)], followed by those with urinary stones [16.08% (168/1 045)], those with hypertension [6.41% (67/1 045)], and those with chronic obstructive pulmonary disease [2.97% (31/1 045)].Conclusion:Gram-negative bacteria are the main pathogens in urine culture, followed by gram-positive bacteria and fungi. The older adults with diabetes mellitus have a higher risk of urinary tract infection compared with young and middle-aged population. The pathogenic bacteria of urinary system infection are complex, so antimicrobial drugs can be selected for targeted treatment according to the recent urine culture results to ensure the rational, safe, and effective use of drugs.

The application value of a cervical collar combined with a vacuum pad in the positioning of Cyberknife radiosurgery for cervical spine metastases / 中华放射医学与防护杂志

Objective:To explore the clinical application value of personalized positioning using a cervical collar combined with a vacuum pad in the Cyberknife radiosurgery for cervical spine metastases.Methods:This study enrolled 68 patients with cervical spine metastases to be treated with Cyberknife stereotactic radiotherapy for cervical spines. These patients consisted of 41 males and 27 females, aged from 43 to 78 years (average: 51.5 years). They were divided into groups A, B, and C using the random number table method. The patient positioning in these groups was achieved using a cervical collar combined with a vacuum pad (personalized positioning), a vacuum pad, and a small head mold, respectively. After the first treatment, the comfort levels of the positioning molds during treatment were investigated. After radiotherapy, the average deviations in translational and rotational directions, the minimum tolerance distance (dxAB), the minimum rotational deviation angle (drAB), the proportion of false nodes, and the comfort level of the three positioning method were acquired for analysis.Results:The three groups showed statistically significant differences in the inf-sup, left-right, ant-post, pitch, roll, and yaw directions during the first treatment ( F = 7.13, 2.56, 3.41, 4.21, 2.71, 8.14, P < 0.05). Compared with groups B and C, Group A had significantly lower dxAB, drAB, and the proportion of false nodes, showing statistically significant differences ( F = 5.06, 4.31, 3.30, P < 0.05). Furthermore, patients in groups A and B felt more comfortable with the positioning molds than those in Group C ( χ2 = 12.46, P < 0.05), with no statistically significant differences between groups A and B ( P > 0.05). Conclusions:For patients with cervical spine metastases undergoing Cyberknife radiosurgery for cervical spines, the personalized positioning using a cervical collar combined with a vacuum pad can improve the accuracy and safety of Cyberknife spinal tracking while remaining the comfort level.

Efficacy and safety of simultaneous modulated accelerated radiation therapy for brain metastases / 中国辐射卫生

Objective To evaluate the clinical efficacy and safety of simultaneous enhanced accelerated radiation therapy for brain metastases (SMART-Brain) combined with functional area protection. Methods SMART-Brain was planned for 60 patients with multiple brain metastases. Using the whole brain intensity modulation technique, important functional areas such as hippocampus were protected against irradiation by delivering a dose of 30 Gy in 10 fractions. Meanwhile, a high dose of 40 Gy was delivered to brain metastases in 10 fractions. All patients were followed up to evaluate the efficacy, incidence of adverse reactions, median overall survival (OS), and intracranial progression-free survival (IPFS). Results The effective rate was 73.33% (44 cases), the disease control rate was 91.67% (55 cases), median OS was 15.2 months, and IPFS was 12 months. The 1 and 2-year OS was 66.7% and 26.4%, and the 1-year IPFS was 46.7%. The MMSE scores at 1, 3, and 6 months after SMART showed no significant differences compared with baseline scores (P > 0.05). Grade 2 and above inner ear damage such as otitis media, hearing loss, and dizziness was absent. Conclusion Smart-Brain can significantly reduce the treatment time and better protect the organs at risk, and serves as an economical, safe, and effective radiotherapy regimen in areas with limited technical conditions.

Analysis of the influence of tracking error of Xsight lung tracking system caused by cardiac beating / 中华放射肿瘤学杂志

Objective:To analyze the influence of tracking error of Xsight lung tracking system caused by cardiac beating.Methods:48 patients with lung tumors adjacent to the heart were enrolled into this study. The tumor movement curves were collected by the Xsight lung tracking system and recorded in the treatment log files during the Cyberknife treatment process. The curves were subject to filtering analysis and the respiratory motion of < 1 Hz and the cardiac beating motion of > 1 Hz were separated. According to the filtering results, the patient treatment tracking data were divided into two groups based on whether the cardiac beating wave of >1 Hz existed. The tracking errors were statistically compared between two groups based on the X-ray imaging data collected by Xsight lung tracking system during treatment.Results:For the fractionation with cardiac beat information, the tracking errors of the patient′s related models were (1.45 ± 0.99), (0.46 ± 0.21) and (0.70 ± 0.54) mm in the left-right, superior-inferior and anterior-posterior direction, respectively. For the fractionation without cardiac beat information, the tracking errors of the patient′s related models were (1.52 ± 1.17), (0.63 ± 0.37) and (1.07 ± 0.62) mm in the left-right, superior-inferior and anterior-posterior direction, respectively. The tracking errors in the superior-inferior and anterior-posterior direction of patients with accurate cardiac beat models were 28.34% and 34.86% less than those of their counterparts without accurate cardiac beat models and there was significant difference (both P<0.05). Conclusion:The tracking accuracy of Xsight lung tracking system will be significantly improved if the cardiac beat model is accurately established.

Dosimetric investigation of non-coplanar field technology in static intensity-modulated radiation therapy for gastric carcinoma / 中国辐射卫生

Objective To compare the dosimetric characteristics of non-coplanar and coplanar field technology in static intensity-modulated radiotherapy of gastric cancer patients, so as to provide a reference for clinical radiotherapy plan selection. Methods Thirty-six patients with gastric cancer were selected to receive intensity-modulated radiotherapy in Huanggang Central Hospital, which was designed plan A and B. Group A used 7-field coplanar technology, while Group B used 7-field non-coplanar technology. We compared the differences of the optimized monitor unit, the dosimetry of organs at risk and target areas between group A and group B. Results Both group A and B could meet the requirements of doctors. The homogeneity index (0.14 ± 0.02), the conformity index (0.98 ± 0.01), Dmin (4315.21 ± 16.74) cGy、Dmean (4679.28 ± 28.39) cGy and Dmax(4952.30 ± 33.26) cGy of target areas in group B were better than those of group A. Moreover, the monitor unit of group B was much lower than that of group A, and the difference was statistically significant (P < 0.05). The Dmax, Dmean, V15, V20 and V30 of the left and right kidneys in group B were lower than those of group A. The Dmax (3408.57 ± 46.03) cGy, Dmean (1250.32 ± 14.27) cGy and V20 (44.91% ± 6.67%) of spinal cord and the Dmax (3408.57 ± 46.03) cGy, Dmean (1720.55 ± 17.42) cGy, V20 (25.31% ± 7.78%) and V30 (18.52% ± 1.56%) of small intestine were also lower than those of group A. The differences were statistically significant (P < 0.05). Conclusion The non-coplanar field radiation plan has more advantages in terms of target dose distribution and protection of organs so that it can be more considerably used in the process of planning and design.

Application of equivalent uniform dose optimization in intracavitary/interstitial brachytherapy for cervical cancer / 中华放射肿瘤学杂志

Objective:To investigate the application of equivalent uniform dose (EUD) in the combination of intracavitary and interstitial brachytherapy (combined-BT) for cervical cancer.Methods:Twenty cervical cancer patients treated with combined-BT in Tianjin Medical University Cancer Institute and Hospital were recruited in this study. For each patient, treatment plans were optimized based on EUD and hybrid EUD (h-EUD). The results were statistically compared with predefined plans generated by Oncentra Brachy v4.3 using hybrid inverse planning optimization (HIPO). Furthermore, virtual uniform interstitial experiments were applied to evaluate the advantage of EUD.Results:All three plans showed consistent conformity index. Compared with the HIPO plans, the average D 2cm 3 of bladder, rectum and intestine in the EUD plans were decreased by 0.22 Gy, 0.23 Gy and 0.28 Gy, and those in the h-EUD plans were declined by 0.16 Gy, 0.22 Gy and 0.24 Gy, respectively. The average EUD of bladder, rectum and intestine in the EUD plans were decreased by 0.14 Gy, 0.20 Gy and 0.15 Gy, and those in the h-EUD plans were declined by 0.20 Gy, 0.13 Gy and 0.16 Gy, respectively (all P<0.05). The virtual interstitial experiment showed EUD could significantly improve the dose sparing for organs at risk (OARs). Conclusion:The application of EUD can significantly improve the dose sparing for normal tissues without compromising dose homogeneity and conformity during combined-BT for cervical cancer.

Advances in the detection of food specific IgG antibodies / 中华检验医学杂志

Food specific IgG antibody detection has been widely carried out at home and abroad in recent years. The controversial issues mainly focus on whether the test is applicable to the diagnosis of allergic diseases, whether it has clear clinical significance, the relevant description in the international allergy guidelines, and the mechanism of action. This paper mainly discussed the above issues, summarized the clinical applicability of food specific IgG antibody detection.

Blood biomarkers for bronchial asthma / 中华检验医学杂志

Bronchial asthma is characterized by airway inflammation, bronchial hyperresponsiveness, and recurrent episodes of reversible airway obstruction. Due to different pathophysiological mechanisms, the disease is very heterogeneous in clinical manifestation, course of disease, response to treatment, phenotype etc. There is a strong need for biomarkers to assess the characteration and severity of the disease. Recently, lymphocyte and blood cells, antibodies, cytokines, chemokines, noncoding RNA and other protein markers have been studied as blood biomarkers of asthma. The present article summarized these biomarkers in diagnosis, phenotyping and treatment efficacy.

A dosimetric study of automated intensity-modulated radiotherapy planning for rectal cancer patients based on Pinnacle3 system / 中华放射医学与防护杂志

Objective To compare the dosimetric differences of the targets and the OARs in rectal cancer patients between Auto-planning and intensity-modulated radiotherapy (IMRT),and explore the advantages of Auto-planning (AP).Methods A total of 10 postoperative radiotherapy rectal cancer patients were selected,whose CT images were used to create AP plan and IMRT plan respectively using Pinnacle3 9.i0 treatment planning system.Through comparing the dose-volume histograms of the two plan types,the differences of the homogeneity index,conformity index and the doses to organs at risk (OARs) were analyzed.Results The AP plans were significantly better (t=-1.36,-3.03,0.37,P＜0.05) in terms of higher D Dmin and lower Dmax.But the differences in D2,Dg5,D98 were insignificant (P＞ 0.05).In the AP plan,the HI values of the target area were significantly reduced,and the CI values were significantly increased (t =1.24,0.10,P＜ 0.05).Significant superior results were found in V40,V50 of bladder,V30,V45,V50 of small intestine,V30,V40 of left and right femoral head (t=-3.21-1.02,P＜ 0.05).AP plans achieved insignificantly lower V30,V45 in bladder,V4o in small intestine and V45 in left and right femoral head than IMRT plan (P＞0.05).Conclusions Compare with IMRT plans,the AP plans for rectal cancer can achieve better homogeneity index,effectively reduce the maximum dose,increase the minimum dose,reduce hot and cold volumes in the target area.Meanwhile,AP plans can also protect the normal tissues better by reducing the dose to the OARs.

Application of indocyanine green fluorescence imaging in laparoscopic liver surgery / 中华肝胆外科杂志

Objective To study the clinical use of indocyanine green (ICG) fluorescence imaging in laparoscopic liver surgery.Methods The clinical and pathological data of 68 patients who underwent laparoscopic hepatectomy using the ICG fluorescence imaging technique during the study period from September 2016 to October 2018 in Zhongnan Hospital,Wuhan University were retrospectively analyzed.Analysis was carried out on the surgical methods,fluorescence navigation methods,ICG injection time and dose,tumor characteristics,and pathological studies of the resected specimens.Results Of 68 patients,3 patients were converted to open surgery,and the remaining 65 patients completed the ICG fluorescence laparoscopic hepatectomy.Thirty-two of these 65 patients underwent ICG fluorescent guided laparoscopic anatomical resection of lower hepatic segment / hepatic hemilivers (positive staining in 17 patients,negative staining in 15 patients),with 19 patients successfully staining with ICG(19 / 32,59.4％).Postoperative histopathology showed primary hepatic solid tumors (n=31),secondary liver tumors (n=12),hepatic cysts (n=4),hepatic hemangiomas (n =5),hepatolithiasis (n =12) and hepatic focal nodular hyperplasia (n =1).These lesions were combined with hepatitis B liver fibrosis in 29 patients.Conclusions ICG fluorescence imaging positively impacted on laparoscopic liver surgery.Proper preoperative ICG injection was helpful for the identification,localization and intraoperative surgical guidance of tumors,especially for patients with deep-seated and central tumors.As a consequence,oncological and surgical safety of laparoscopic liver surgery was improved.Targeted visualization of liver segments and surgical navigation using intraoperative ICG injections facilitated accurate and precise resection of anatomical liver segments or hemi-hepatectomies.The use of intraoperative ICG fluorescence technology for hepatic hemangioma,hepatic cyst,intrahepatic bile duct stones and other benign liver lesions,helped to improve safety of surgery.

Impact of co-cultured microglia and neural stem cells via transwell on differentiation from neural stem cells into dopaminergic neurons / 中华神经医学杂志

Objective To investigate the influence of co-culture of microglia and neural stem cells (NSCs) on differentiation from NSCs into dopaminergic neurons in vitro.Methods (1) The microglia from neonatal SD rats was purified and identified.After the NSCs were isolated from 14-day pregnant SD rats,the cells were cultured and identified.(2) The identified NSCs were randomly divided into 2 groups:simple NSCs culture group and NSCs+microglia co-culture group.After the cells in both groups were cultured for 6 days,immunofluorescence assay and Westem blotting were performed to detect the protein expression of TH,DAT and Pitx3,the factors associated with the differentiation and maturity of dopaminergic neurons.(3) PCR was used to detect the gene transcription of TH,DA T and Pitx3 in the cells from the 2 groups and differences were compared between the 2 groups.Results (1)The staining of CD1 1b/c in the microglia mixed cultured in the neonatal SD rats was positive,with a purity of above 95％;the staining of NSCs identified via nestin was positive in the 14-day pregnant SD rats.(2) The immunofluorescence assay showed that the amounts of positive proteins of TH,DAT and Pitx3 in the NSCs+microglia co-culture group were significantly larger than in the simple NSCs culture group (P＜0.05).The Western blotting showed that the protein expression levels ofTH,DAT and Pitx3 in the NSCs+microglia co-culture group were significantly higher than in the simple NSCs culture group (P＜0.05).(3) The PCR detection showed that the gene transcription levels of TH,DA T and Pitx3 in the NSCs+microglia co-culture group were significantly higher than in the simple NSCs culture group (P＜0.05).Conclusion Co-culture of NSCs and microglia via Transwell may promote differentiation from NSCs into dopaminergic neurons.

Changes of 25-hydroxy vitamin D and vitamin D binding protein in critically ill chidren and its clinical significance / 中国小儿急救医学

Objective To investigate the 25-hydroxy-vitamin D[25(OH)D] and vitamin D binding protein ( VBDP) levels in critically ill children admitted to PICU,their clinical significance and the relation-ship with prognosis. Methods Two hundred and ninty-five children with critical illness admitted to PICU from February 2015 to July 2016 were enrolled as subjects( study group) and 44 healthy controls were recrui-ted. Serum 25(OH)D and VDBP levels were measured on the 1st and 7th day of PICU,then clinical data were collected for statistical analysis. Results (1) Among subjects,there were no statistically significant differ-ences in the incidences of 25(OH)D deficiency and VDBP decline(P>0. 05). (2)The levels of 25 (OH)D and VDBP in the study group were lower than those in the control group [ ( 61. 38 ± 29. 42 ) nmol/L vs. (97. 11 ± 30. 11) nmol/L; (514. 36 ± 211. 13)μmol/L vs. (840. 82 ± 448. 96)μmol/L,respectively,P <0. 05]. (3) There were no significant differences in the level of VDBP ,28-day mortality,organ failure rate and mechanical ventilation rate among 25(OH)D adequate group(n=85),inadequate group(n=97) and deficient group( n=113 ) ( P>0. 05 ) . The duration of PICU stay,PRISMⅢscores were significantly longer and higher (P<0. 05) in 25(OH)D inadequate group or deficient group than those of 25(OH)D adequate group.(4) Compare to the 7th day ,the levels of 25(OH)D and VDBP were lower (P <0.05) and PRISM Ⅲscores was higer on the 1st day in the cases staying in PICU≥7 d[ (71. 14 ± 31. 78)nmol/L vs. (60.65 ±30.77)nmol/L;(532.23 ±148.49)μmol/L vs. (484.73 ±128.17)μmol/L;2.0(0.0 ～5.0) scores vs. 5. 0(3. 0～8. 0)scores,respectively,P<0. 05]. (5) Among the 295 cases of critically ill children ,the 28-day mortality was 12. 9％(38/295),the death patients showed lower 25(OH)D status[ (51. 17 ± 29.65)nmol/L vs. (62.89 ±29.15)nmol/L,P <0.05] and higher PRISM Ⅲ score[ 8.5(5.0 ～14.3) scores vs. 4. 0(1. 0～7. 0) scores,P<0. 05 ]than those of the survival. Conclusion (1)The prevalences of 25(OH)D and VDBP insufficient and deficiency among critically ill children are high. (2) Patients with 25(OH)D insufficiency and deficiency show a poorer prognosis than those with sufficient 25(OH)D. (3) The change of 25(OH)D status is not completely consistent with the VDBP.

Clinical Study of the Analgesic Effect of Acupuncture plus Medication on Acute Exacerbation of Chronic Cholecystitis / 上海针灸杂志

Objective To investigate the relieving effect of acupuncture plus medication on persistent right upper abdominal and scapular pains during acute exacerbation of chronic cholecystitis.Method One hundred patients with acute exacerbation of chronic cholecystitis were randomly allocated to treatment and control groups, 50 cases each. The control group received medication and the treatment group, acupuncture at points Yanglingquan, Dannang and Taichong in addition. Both groups were treated once daily, for a total of seven days. Liver function indicators (alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total bilirubin (TBIL) and direct bilirubin (DBIL)) were measured and the VAS score was recorded in the two groups before and after treatment. The clinical therapeutic effects were compared between the three groups.Result There were statistically significant pre-/post-treatment differences in the liver function indicators and the VAS score in the three groups (P<0.05). There were statistically significant post-treatment differences in TBIL and DBIL, and the VAS score between the treatment and control groups (P<0.05). The total efficacy rate was 98% in the treatment group and 50% in the control group; there was a statistically significant difference between the two groups (P<0.05).Conclusion Acupuncture plus medication can effectively relieve the pain induced by acute exacerbation of chronic cholecystitis and improve the liver function indicators in the patients.