Dosimetric comparison between dIMRT and VMAT for bilateral breast cancer / 中国辐射卫生

Objective To compare the dosimetric difference of target and organs-at-risk between intensity-modulated radiotherapy (dIMRT) and volumetric modulated arc therapy (VMAT) for bilateral breast cancer, so as to discuss the clinical feasibility of radiotherapy for bilateral breast cancer. Methods The clinical data of 18 patients receiving radical or modified radical mastectomy for confirmed bilateral breast cancer were enrolled in this study. dIMRT plans and VMAT plans were designed for each patient, and discuss the dosimetric data of two radiotherapy plans. Results Both the two plans satisfied the prescription. In terms of the homogeneity index, VMAT plans (0.09 ± 0.02) were superior to dIMRT plans (0.11 ± 0.01, P < 0.05). In terms of the conformity index,VMAT plans (0.82 ± 0.52) were superior to dIMRT plans (0.71 ± 0.51, P < 0.05). Furthermore, VMAT plans (0.98 ± 0.06) were superior to dIMRT plans (1.24 ± 0.08, P < 0.05) in the dose gradient index. The V10、V20、V30 and Dmean of lungs in VMAT plans (39.07 ± 4.92，22.19 ± 4.36，12.81 ± 4.71，1309.03 ± 135.55) were higher than those in dIMRT plans (30.34 ± 4.26，17.56 ± 4.31，6.77 ± 3.93，1201.39 ± 166.77, P < 0.05).Meanwhile, the V5 of lungs in VMAT plans (63.36 ± 9.02) was higher than that in dIMRT plans (58.01 ± 7.17, P > 0.05). However, the V5、V30 and Dmean of heart in VMAT plans (51.98 ± 3.60，3.78 ± 1.76，885.89 ± 59.84) were lower than those in dIMRT plans (77.16 ± 12.11，5.22 ± 2.85，1036.96 ± 151.46, P < 0.05). The Dmax of spinal cord in VMAT plans (2150.42 ± 136.19) was significantly lower than that in dIMRT plans (3008.23 ± 304.15, P < 0.05). Monitor units in VMAT plans（792.61 ± 62.53）was significantly lower than that in dIMRT plans (3225.33 ± 498.66, P < 0.05). Conclusion Although VMAT has many advantages: achieves better homogeneity index and conformity index of target areas, reduces the irradiation dose of organs-at-risk, especially, the irradiation dose of heart and spinal cord is significantly reduced, however, it increases the irradiation dose of lungs. To reduce the recurrence of grade ≥ 2 radiation pneumonia, dIMRT should be better considered in the application of radiotherapy for bilateral breast cancer.

Metabolic indicators associated with non-communicable diseases deteriorated in COVID-19 outbreak: evidence from a two-center, retrospective study

ObjectiveOur study aimed to investigate whether the metabolic indicators associated with non-communicable diseases (NCDs) in the general population have changed during the COVID-19 outbreak. METHODSThis retrospective self-controlled study enrolled adult participants with metabolic indicators relate to NCDs followed at Fujian Provincial Hospital and Fujian Provincial Hospital South Branch. The metabolic indicators followed during January 1, 2020 and April 30, 2020, the peak period of the COVID-19 epidemic in China, were compared with the baseline value in the same period last year. Pared-samples T-test and Wilcoxon signed-rank test were performed to analyze the differences between paired data. ResultsThe follow-up total cholesterol was significantly increased than that of the baseline (4.73 (4.05, 5.46) mmol/L vs 4.71 (4.05, 5.43) mmol/L, p=0.019; n=3379). Similar results were observed in triglyceride (1.29 (0.91, 1.88) vs 1.25 (0.87, 1.81) mmol/L, p<0.001; n=3381), uric acid (330.0 (272.0, 397.0) vs 327.0 (271.0, 389.0) umol/L, p<0.001; n=3364), and glycosylated hemoglobin (6.50 (6.10, 7.30) vs 6.50 (6.10, 7.20) %, p=0.013; n=532). No significant difference was observed in low density lipoprotein, body mass index and blood pressure. ConclusionsMetabolic indicators associated with NCDs deteriorated in the COVID-19 outbreak. We should take action to prevent and control NCDs without delay.

Thoughts on Higher Medical Education Under Major Public Health Emergencies: Thinking Ahead After COVID-19 Outbreak

ImportanceThe spread of coronavirus disease 2019 (COVID-19) has posed great threat to peoples health and several medical schools in the world suspended classes as a precaution against the virus. China has also adopted precautionary measures to keep medical schools running without suspending classes. Thinking ahead after COVID-19 Outbreak is important. ObjectiveTo explore the most suitable teaching and learning pattern in medical school during COVID-19 Outbreak. DesignThis study is a case-control study. We had tried to apply a new blended teaching model based on 5G network that combined team-based learning (TBL) and online interaction to the students before the outbreak and then universities responded to the COVID-19 outbreak by closing campuses and shifting to other forms of distance learning. In other word, the courses started using blended teaching model before COVID-19 outbreak and might last using other forms of distance learning throughout the pandemic. Five Point Likert Scale Questionnaires which contains 20 items were used, and the effect of the two kinds of teaching patterns was compared by evaluating the indicators of core competencies of students including professionalism, attitude towards learning, knowledge and learning skills, teamwork skills, motivation in learning, adaptability and acceptance of the courses and network environment. SettingOur study based on a single center. ParticipantsFifty fourth-year medical students receiving the "5+3" pattern courses regarding internal medicine were enrolled in the study. Exposure(s) (for observational studies)The teaching and learning patter started using blended teaching model before COVID-19 outbreak and might last using other forms of distance learning throughout the pandemic. Main Outcome(s)According to the descriptive statistical analysis of the first part of the questionnaire (question 1-16), the average score of adaptability and acceptance of the courses is 2.60 lower than 3, indicating that students are more adapted to other forms of distance learning during COVID-19 outbreak; the average score of the rest of the questions is higher than 3, indicating that blended teaching model based on 5G network is superior to other forms of distance learning. The number of male students who are inclined to the blended teaching model based on 5G network is 0.13 times as much as that of female students (95%CI:0.028[~]0.602, p=0.009). ResultsOnline forms of distance learning were accepted by the students. Female students had higher expectations on the course and were more likely to adapt well to the change during the COVID-19 outbreak. However, all students preferred the blended teaching model based on 5G network that combined team-based learning (TBL) and online interaction before the pandemic. ConclusionIt indicates that medical education based on 5G network that combined team-based learning (TBL) and online interaction is a more suitable option to teach medical students online. Chinas experience in online higher medical education may serve as a reference to other countries during the pandemic. Key pointO_ST_ABSQuestionsC_ST_ABSWhat are the reflections on approaches to teaching and learning during COVID-19 Outbreak? FindingsFifty fourth-year medical students receiving the "5+3" pattern courses regarding internal medicine were enrolled. Five Point Likert Scale Questionnaires which contains 20 items were used. This study indicates that medical education based on 5G network that combined team-based learning (TBL) and online interaction is a more suitable option to teach medical students online during COVID-19 outbreak. MeaningChinas experience in online higher medical education may serve as a reference to other countries during the pandemic.

Approach to the patient with Klinefelter syndrome combined with neuropsychological abnormality / 中华内分泌代谢杂志

Klinefelter syndrome(KS) is the most common sex chromosome disorder in males,which is caused by the presence of the extra X chromosome that maybe inherited from mother or father. Approximately 80% karyotype of the cases is 47,XXY. KS is characterized by small firm testes, hypergonadotropic hypogonadism, infertility,gynaecomastia, increased height. However, cognitive disabilities and psychiatric disorders are rarely diagnosed in KS because they lack screening in related aspects. At the present, the pathogenesis of cognitive disabilities and increased risk of psychiatric diseases in KS have not been delineated. In this article,we report two cases of KS,and review their clinical manifestations,diagnosis,and treatments.

Approach to the patient with Kallmann syndrome / 中华内分泌代谢杂志

Kallmann syndrome ( KS) is a rare disease and characteristic of an absence of puberty, infertility, and a defective sensation of smell (anosmia or hyposmia). Here, we analyze the features of a case of KS diagnosed clinically. In addition, the etiology, genetic features, clinical manifestations, diagnosis, and treatment of KS were reviewed.

Association of napping and night-time sleep with impaired glucose regulation, insulin resistance and glycated haemoglobin in Chinese middle-aged adults with no diabetes: a cross-sectional study.

OBJECTIVE: To assess associations between napping and night-time sleep duration with impaired glucose regulation, insulin resistance (IR) and glycated haemoglobin (HbA1c). DESIGN: Cross-sectional study. SETTING: Fujian Province, China, from June 2011 to January 2012. PARTICIPANTS: This study enrolled 9028 participants aged 40-65 years. Data of 7568 participants with no diabetes were included for analysis. Type 2 diabetes was defined applying WHO criteria. OUTCOME MEASURES: Participants' daytime napping and night-time sleep duration data were collected using a standardised self-reported Chinese-language questionnaire about sleep frequency and quality. Anthropometric and laboratory parameters were also measured. IR was defined as a HOMA-IR index value >2.50. ORs and 95% CIs were derived from multivariate logistic regression models. RESULTS: Participants (mean age 51.1±7.0 years) included 3060 males and 4508 females with average night-time sleep of 7.9 h. A higher proportion of males napped than females. After adjustment for potential confounders, ORs for HbA1c >6.0% were 1.28 and 1.26 for those napping ≤1 h and >1 h (p=0.002 and p=0.018), respectively. Statistically significant differences in IR between nappers and non-nappers were only marginal clinically. Odds for HbA1c >6.0% were significantly lower in participants with longer night-time sleep durations than in the reference group (>8 h vs 6-8 h). Odds for IR were significantly lower in participants whose night-time sleep hours deviated from the reference group (<6 h, >8 h vs 6-8 h) CONCLUSIONS: Chinese middle-aged adults with no diabetes who napped had higher HbA1c and IR; those with shorter night-time sleep durations had increased HbA1c. Night-time sleep hours that are either <6 or >8 tend to be associated with lower odds for IR. Further studies are necessary to determine the underlying clinical significance and mechanisms behind these associations.

AMP-activated protein kinase inhibits KiSS-1 gene expression through SP1 in the hypothalamic GT1-7 neurons / 中华内分泌代谢杂志

The effect of AMP-activated protein kinase (AMPK) on KiSS-1 mRNA levels was detected by realtime PCR in the hypothalamic GT1-7 neurons. The promoter activity of KiSS-1 gene was detected by DualLuciferase Reporter Assay System.The effects of AMPK on the protein expression and subcellular distribution of SP1 were determined by Western blot.The results showed that AMPK reduced the mRNA expression and promoter activity of KiSS-1 gene while SP1 increased the promoter activity of KiSS-1 gene. Besides,AMPK alse decreased the translocation of SP1.These results suggest that AMPK may inhibit the expression of KiSS-1 gene by decreasing the translocation of SP1 from cytoplasm to nucleus in the hypothalamus GT1-7 neurons.

Clinical features of 239 cases of pituitary adenomas / 中华内分泌代谢杂志

Objective To study clinical feature and therapeutic choice of pituitary adenomas. Methods The clinical data of 239 cases of pituitary adenomas were analyzed. Results Total 93 male and 146 female cases were recruited. The average age was (43.8 ± 14.9 ) years old (3.9-77 years). Prolactinomas were the most common pituitary adenomas (26.8%) , 179 patients (74.9%) underwent surgery, of which 108 (60.3%) with transsphenoidal approach and 71 (39.7%) transcranial approach. The other 60 cases were treated nonsurgically. Conclusions Pituitary adenomas may present hormonal abnormalities or neurological symptoms.Some adenomas were accidently detected by MRI. Prolactinomas were the most common pituitary adenomas.

Association of arteriosclerosis with mild cognitive impairment in type 2 diabetics / 中华内分泌代谢杂志

Montreal cognitive assessment(MoCA, Beijing Version) was chosen as cognition assessment implement. 63 patients suffering from type 2 diabetes mellitus with mild cognitive impairment (MCI) were chosen to form a research group, and 27 patients with type 2 diabetes mellitus and normal cognitive function served as a control group. It was found that atherosclerosis played an important role in the pathogenesis of MCI in type 2diabetes, therefore, early prevention and management of atherosclerosis may help to improve the cognitive function.

Assessment implement and its related factors in type 2 diabetic patients with mild cognitive impairment / 中华内分泌代谢杂志

Objective To study the assessment implement and its related factors in type 2 diabetic patients with mild cognitive impairment(MCI).Methods Montreal Cognitive Assessment(MoCA)(Beijing Version)was chosen as cognition assessment implement.58 type 2 diabetic patients with MCI were enrolled as the research group and 30 type 2 diabetic patients with normal cognitive function as control.HbA_(1C),blood lipid,urine microalbumin,liver and renal functions were measured in all subjects.Results Compared with control group,the blood levels of HbA_(1C)[(10.48±2.38 vs 9.28±2.19)%,P<0.05],total cholesterol[(4.87±1.18 vs 4.18±1.04)mmol/L,P<0.01],and low-density lipeprotein-cholesterol[LDL-C,(2.97±0.87 vs 2.37±0.61)mmol/L,P<0.01]increased,and high-density lipoprotein-cholesterol decreased[(1.084±0.34 vs 1.25±0.33)mmoL/L,P<0.05]in MCI group.There were significant differences in the duration of diabetes mellitus,diabetic retinopathy,body mass index,and abdominal circumference between MCI group and control group(all P<0.05).There were no significant differences in blood triglycerides,alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine,and urine microalbumin between the two groups.MoCA scores were negatively correlated with HbA_(1C)(r=-0.396,P=0.002)and LDL-C(r=-0.275,P=0.036)in MCI group.Multiple regression analysis showed that HbA_(1C) was a significantly independent determinant for the MoCA scores.Conclusion The risk factors such as longer duration of diabetes mellitus.more diabetea mellitus complications,obesity,dyslipidemia,and inefficient control of blood glucoge all contribute to the development and aggravation of cognitive impairment.Therefore,good control of blood glucose and lipids,and reduction of complication and body weight may help to improve the cognitive function.