Establishment and application of animal models for portal vein thrombosis / 临床肝胆病杂志

Portal vein thrombosis （PVT） refers to thromboembolism that occurs in the extrahepatic main portal vein and/or intrahepatic portal vein branches. PVT is the result of the combined effect of multiple factors， but its pathogenesis remains unclear. Animal models are an important method for exploring the pathophysiological mechanism of PVT. Based on the different species of animals， this article reviews the existing animal models of PVT in terms of modeling methods， principles， advantages and disadvantages， and application.

Treatment outcomes of multidrug-resistant tuberculosis patients receiving ambulatory treatment in Shenzhen, China: a retrospective cohort study.

Background: WHO recommended multidrug-resistant tuberculosis (MDR-TB) should be treated mainly under ambulatory model, but outcome of ambulatory treatment of MDR-TB in China was little known. Methods: The clinical data of 261 MDR-TB patients treated as outpatients in Shenzhen, China during 2010-2015 were collected and analyzed retrospectively. Results: Of 261 MDR-TB patients receiving ambulatory treatment, 71.1% (186/261) achieved treatment success (cured or completed treatment), 0.4% (1/261) died during treatment, 11.5% (30/261) had treatment failure or relapse, 8.0% (21/261) were lost to follow-up, and 8.8% (23/261) were transferred out. The culture conversion rate at 6 months was 85.0%. Although 91.6% (239/261) of patients experienced at least one adverse event (AE), only 2% of AEs caused permanent discontinuation of one or more drugs. Multivariate analysis showed that previous TB treatment, regimens containing capreomycin and resistance to FQs were associated with poor outcomes, while experiencing three or more AEs was associated with good outcomes. Conclusion: Good treatment success rates and early culture conversions were achieved with entirely ambulatory treatment of MDR-TB patients in Shenzhen, supporting WHO recommendations. Advantageous aspects of the local TB control program, including accessible and affordable second-line drugs, patient support, active monitoring and proper management of AEs and well-implemented DOT likely contributed to treatment success rates.

CBCT-based synthetic CT generated using CycleGAN with HU correction for adaptive radiotherapy of nasopharyngeal carcinoma.

This study aims to utilize a hybrid approach of phantom correction and deep learning for synthesized CT (sCT) images generation based on cone-beam CT (CBCT) images for nasopharyngeal carcinoma (NPC). 52 CBCT/CT paired images of NPC patients were used for model training (41), validation (11). Hounsfield Units (HU) of the CBCT images was calibrated by a commercially available CIRS phantom. Then the original CBCT and the corrected CBCT (CBCT_cor) were trained separately with the same cycle generative adversarial network (CycleGAN) to generate SCT1 and SCT2. The mean error and mean absolute error (MAE) were used to quantify the image quality. For validations, the contours and treatment plans in CT images were transferred to original CBCT, CBCT_cor, SCT1 and SCT2 for dosimetric comparison. Dose distribution, dosimetric parameters and 3D gamma passing rate were analyzed. Compared with rigidly registered CT (RCT), the MAE of CBCT, CBCT_cor, SCT1 and SCT2 were 346.11 ± 13.58 HU, 145.95 ± 17.64 HU, 105.62 ± 16.08 HU and 83.51 ± 7.71 HU, respectively. Moreover, the average dosimetric parameter differences for the CBCT_cor, SCT1 and SCT2 were 2.7% ± 1.4%, 1.2% ± 1.0% and 0.6% ± 0.6%, respectively. Using the dose distribution of RCT images as reference, the 3D gamma passing rate of the hybrid method was significantly better than the other methods. The effectiveness of CBCT-based sCT generated using CycleGAN with HU correction for adaptive radiotherapy of nasopharyngeal carcinoma was confirmed. The image quality and dose accuracy of SCT2 were outperform the simple CycleGAN method. This finding has great significance for the clinical application of adaptive radiotherapy for NPC.

Evaluation of auto-planning in VMAT for locally advanced nasopharyngeal carcinoma.

The aim of this study is to demonstrate the feasibility of a commercially available Auto-Planning module for the radiation therapy treatment planning for locally advanced nasopharyngeal carcinoma (NPC). 22 patients with locally advanced NPC were included in this study. For each patient, volumetric modulated arc therapy (VMAT) plans were generated both manually by an experienced physicist and automatically by the Auto-Planning module. The dose distribution, dosimetric parameters, monitor units and planning time were compared between automatic plans (APs) and manual plans (MPs). Meanwhile, the overall stage of disease was factored into the evaluation. The target dose coverage of APs was comparable to that of MPs. For the organs at risk (OARs) except spinal cord, the dose parameters of APs were superior to that of MPs. The Dmax and V50 of brainstem were statistically lower by 1.0 Gy and 1.32% respectively, while the Dmax of optic nerves and chiasm were also lower in the APs (p < 0.05). The APs provided a similar or superior quality to MPs in most cases, except for several patients with stage IV disease. The dose differences for most OARs were similar between the two types of plans regardless of stage while the APs provided better brainstem sparing for patients with stage III and improved the sparing of the parotid glands for stage IV patients. The total monitor units and planning time were significantly reduced in the APs. Auto-Planning is feasible for the VMAT treatment planning for locally advanced NPC.

Differential gene sequencing alignment analysis of hyperplastic stenosis in murine arteriovenous fistula / 中华肾脏病杂志

Objective:To establish a mouse model of intra-jugular arteriovenous fistula (AVF) to screen differentially expressed genes in the process of intimal stenosis of AVF for investigating the abnormal expression signaling pathways and the mechanisms.Methods:Forty-six male C57BL/6 mice were randomly divided into AVF group ( n=23) and sham-operated group ( n=23). The AVF group underwent internal jugular arteriovenous fistuloplasty, and the sham-operated group separated the right external jugular vein and common carotid artery and then sutured the incision. The whole-genome sequences of mice with AVF stenosis were determined by transcriptomic reversible chain terminator and synthetic sequencing. The microarray data set was established, and the Benjamini & Hochberg method of gene microarray data analysis was applied to screen the differentially expressed genes. The differentially expressed genes were screened by R-language enrichment analysis. Then, gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) were performed. The subcellular localization of the differentially expressed genes was performed by BUSCA software. The protein network interaction of differentially expressed genes was analyzed by using STRING database and Cytoscape software. Results:In the AVF group, 21 mice were successfully modeled and 2 mice failed. Therefore, there were 21 mice in the AVF group and only 21 mice in the sham-operated group. This mouse internal jugular AVF model was innovated using the continuous-interrupted suture method, which improved the success rate of modeling this model. The differential gene sequencing analysis showed that there were 2 514 differentially expressed genes in the AVF process, including 1 323 up-regulated genes and 1 191 down-regulated genes. GO functional enrichment analysis showed that the differential genes were mainly enriched in metabolic process, activation, redox, mitochondria and so on. KEGG pathway enrichment analysis showed that the differential genes were enriched in metabolism, energy substance synthesis, diabetes, oxidative stress and so on. Statistical analysis of subcellular localization showed that the differences were mainly in mitochondrial proteins (24.24%), cytoplasmic proteins (17.51%), nuclear proteins (13.13%), cell membrane proteins (11.45%), and extracellular proteins (10.77%).Conclusions:Mitochondrial oxidative stress injury may be involved in the pathological damage process of endothelial proliferation stenosis in the AVF.

Etiological diagnostic value of cerebrospinal fluid metagenomic next-generation sequencing in central nervous system infection / 中华急诊医学杂志

Objective:To investigate the etiological diagnostic value of metagenomic sequencing in central nervous system (CNS) infectious diseases.Methods:A total of 170 patients with central nervous system infection admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2020 were selected as the study subjects according to inclusion and exclusion criteria. General clinical data and pathogen test results were collected. All included patients underwent routine examination and mNGS test, and were divided into the conventional method test group and mNGS test group according to the test results. The measurement data conforming to normal distribution were represented by ± s; The measurement data that did not conform to normal distribution were represented by median and interquartile range. The classification data were expressed by the number of cases and percentage( n,%), and were compared by χ2 test or Fisher's exact test. Consistency test was represented by Kappa value. The detection of pathogenic microorganisms by the two methods and the rule of pathogen spectrum were compared and analyzed. Results:The overall positive rate of mNGS in CNS infectious diseases was higher than that of conventional methods (58.23% vs. 18.82%), and the difference was statistically significant ( P<0.01). Among the 20 samples which were both positive by the two methods, 10 cases were completely pathogenic, 5 cases were partially consistent and 5 cases were completely inconsistent. In the detection of tuberculous nervous system infection, the positive rates were 66.7%, 53.8%, 44.0%, 40.0%, 4.0% in blood T-SPOT, cerebrospinal fluid mNGS, ADA, Mycobacterium tuberculosis DNA and tuberculous specific antibody, respectively. The positive rate of acid-fast staining was 0. The positive rate of mNGS combined with conventional method was 80.8%. Conclusions:The detection rate of mNGS in CNS infection is better than that of conventional methods. However, it does not show obvious superiority in the detection rate of Mycobacterium tuberculosis associated nervous system infection. In general, mNGS detection of pathogenic bacteria is more extensive, which is conducive to a thorough and comprehensive understanding of the bacterial characteristics of central nervous system infection. The combination of the two methods can make up for the deficiency of clinical routine detection to a certain extent, and can maximize the detection rate.

The mechanism of ischemic preconditioning renal tubular cell-derived exosomes in the repair of renal ischemia-reperfusion injury in rats / 中国医师杂志

Objective:Clamping bilateral renal arteries with refined surgical methods to establish the rat renal ischemia-reperfusion injury (RIRI) model, and study the protective mechanism of ischemic preconditioning renal (IPC) tubular cell-derived exosomes in RIRI.Methods:25 female Sprague Dawley (SD) rats were divided into sham group, model group, inactivated group, normoxic group, IPC group. In the sham operation group, after bilateral renal arteries were dissociated, the back incision was disinfected and closed. The model group established RIRI model; RIRI models were established in inactivated group, normoxia group and IPC group, and then 200 μg of inactivated exosomes, normal exosomes and IPC exosomes were injected into the caudal vein 24 hours after operation. Serum creatinine (Scr) and urea nitrogen (BUN) levels were detected. The pathological changes of renal tissue were observed under light microscope. Transmission electron microscopy (TEM) was used to observe the shape and size of renal tubular exosomes. Nanoparticle tracking analysis (NTA)was used to detect the concentration and size of renal tubular exosomes.Results:Compared with the sham group, the Scr and BUN levels in the model group were significantly elevated ( P<0.01). Renal pathological changes in the model group showed damaged of the tubular structure, necrosis and shedding of tubular epithelial cells, and a large number of inflammatory cells accumulated in the renal interstitial tissue with varying degrees of edema. Compared with the inactivated group, the Scr and BUN levels significantly decreased in the normoxic group and IPC group ( P<0.01). Renal pathological changes in the normoxic group and IPC group showed that the renal tubular cell necrosis alleviated, inflammatory was reduced, the improved edema. Compared with the normoxic group, the Scr and BUN levels in the IPC group were further reduced ( P<0.01). Renal pathological changes in the IPC group showed that the inflammatory cells were significantly reduced, the cell edema was significantly improved, and the cell apoptosis was significantly reduced. Conclusions:Clamping bilateral renal arteries with refined surgical methods is the main and optimal way to build a rat model of RIRI. IPC tubular cell-derived exosomes have protective and repair effects on RIRI.

Predictors and Trends of MDR/RR-TB in Shenzhen China: A Retrospective 2012-2020 Period Analysis.

PURPOSE: We analyzed the trends and predictors of multidrug-resistant (MDR) or rifampicin-resistant (RR) tuberculosis (TB) in culture-positive cases in Shenzhen during 2012-2020, after the implementation of improved strategies (scale-up molecular drug susceptibility testing [mDST], expansion of DST eligibility, and generous reimbursement of MDR-TB outpatient care costs). MATERIALS AND METHODS: We retrospectively extracted and analyzed data from the TB Information System on drug-resistant pulmonary tuberculosis diagnosed in Shenzhen during the 2012-2020 period. We analyzed trends in RR- and MDR-TB rates in new cases during 2012-2018 and 2018-2020 periods, and among previously-treated cases during 2012-2017 and 2017-2020 periods, using Cochran-Armitage tests. We generated multivariate logistic regression models to analyze demographic predictors of MDR/RR-TB rates. RESULTS: We found 21,367 positive mycobacterial cultures in Shenzhen during the 2012-2020 period, and 19,951 (93.4%) were identified as Mycobacterium tuberculosis and had DST results (92.0% of those were mDST-based). Of these patients with DST results, 1630 (8.2%) were RR-TB, and 1142 (5.7%) were MDR-TB. Of the RR-TB, 70% were MDR-TB. The MDR/RR-TB rate in new TB cases increased significantly during the 2012-2018 period (P trend < 0.05), but it decreased in the 2018-2020 period (P trend > 0.05, with a significant trend for MDR-TB). Among previously treated cases, the temporal MDR/RR-TB rate trends did not differ significantly (P trend > 0.05). Our multivariate analysis showed that age younger than 30 years, housework service/unemployment, local residency, and previous TB treatment were all predictors of MDR/RR-TB. The percentage of patients with MDR-TB on treatment increased from 49.4% in 2012 to 70.5% in 2020. The treatment success rate of patients with MDR-TB during the 2012-2018 period was 71%. CONCLUSION: During the study period in Shenzhen, the cases of MDR/RR-TB were detected, and the treatment enrollment increased and the MDR-TB rates decreased gradually after 2017. Decreasing trends may reflect the efficacy of improved strategies; however, their long-term impact on the MDR-TB burden remains to be investigated. The predictors of MDR-TB identified in our study should be considered when developing targeted MDR-TB control strategies.

Uric acid induces inflammatory injury in HK-2 cells via PI3K/AKT/NF-κB signaling pathway / 中华肾脏病杂志

Objective:To investigate the effects and underlying mechanisms of phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/NF-κB signaling pathway in human kidney-2(HK-2) cells of hyperuricemic nephropathy.Methods:HK-2 cells were cultured in vitro and randomly divided into control group and experimental group. The experimental group was induced by high uric acid (720 μmol/L) immersion for 48 h to establish a cell model of hyperuricemic nephropathy in vitro and subsequently divided into hyperuricemic group, overexpressed protease activated receptor 2 (PAR2) and knockdown PAR2 group. The expressions of PAR2, PI3K, AKT, NF-κB mRNA were measured by real-time PCR. The expressions of PAR2, PI3K, AKT and NF-κB protein were measured by Western blotting. The expressions of tumor necrosis factor-α (TNF-α), monocyte chemotactic protein-1 (MCP-1), interleukin-6 (IL-6), pro-interleukin-1β (pro-IL-1β), interleukin-1β (IL-1β) and transforming growth factor-β1 (TGF-β1) were detected by enzyme linked immunosorbent assay (ELISA). Results:(1) Compared with the control group, the expressions of PAR2, PI3K, AKT and NF-κB mRNA and protein in hyperuricemic group were significantly increased (all P<0.05), the expressions of TNF-α, MCP-1, IL-6, pro-IL-1β, IL-1β and TGF-β1 in the supernatant in hyperuricemic group were significantly increased (all P<0.01). (2) Compared with the hyperuricemic group, the expressions of PAR2, PI3K, AKT and NF-κB mRNA and protein in overexpressed PAR2 group were significantly increased (all P<0.05), the expressions of TNF-α, MCP-1, IL-6, IL-1β and TGF-β1 in the supernatant were significantly increased (all P<0.05). (3) Compared with the hyperuricemic group, the expression of PAR2, PI3K, AKT and NF-κB mRNA and protein in knockdown PAR2 group were significantly decreased (all P<0.05), the expressions of IL-6, pro-IL-1β, IL-1β and TGF-β1 in the supernatant were significantly decreased (all P<0.05). Conclusions:In the process of uric acid-induced HK-2 cell damage, uric acid significantly up-regulates the expression of PI3K/AKT/NF-κB signaling pathway by activating PAR2, leading to a marked increase in inflammatory damage. Knocking down PAR2 inhibits the expression of PI3K/AKT/NF-κB signaling pathway, which can effectively reduce the inflammatory damage of HK-2 cells.

Automated Intensity Modulated Radiation Therapy Treatment Planning for Cervical Cancer Based on Convolution Neural Network.

PURPOSE: To develop and evaluate an automatic intensity-modulated radiation therapy (IMRT) program for cervical cancer, including a Convolution Neural Network (CNN)-based prediction model and an automated optimization strategy. METHODS: A CNN deep learning model was trained to predict a patient-specify set of IMRT objectives based on overlap volume histograms (OVH) and high-quality plan of previous patients. A total of 140 cervical cancer patients were enrolled in this study, including 100 patients in the training set, 20 patients in the validation set and 20 patients in the testing set. The input of this model was OVH data and the output were values of IMRT plan objectives. For patients in the testing set, the set of planning objectives were predicted by the CNN model and used to automatically generate IMRT plans. Meanwhile, manual plans of these patients were generated by 1 beginner planner and 1 senior planner respectively. Finally, dose distribution, dosimetric parameters and planning time were analyzed. In addition, the 3 types of plans were blinded compared and ranked by an experienced oncologist. RESULTS: There were almost no statistically differences among these 3 types of plans in target coverage and dose conformity. Dose homogeneity were slightly decreased while the average dose and parameters for most organs-at-risk (OARs) were decreased in automatic plans. Especially in comparison with manual plans by the beginner planner, V40 of bladder and rectum decreased 6.3% and 12.3%, while mean dose of rectum and marrow were 1.1 Gy and 1.8 Gy lower with automatic plans (either P < 0.017). In the blinded comparison, automatic plans were chosen as best plan in 14 cases. CONCLUSIONS: For cervical cancer, automatic IMRT plans optimized from the CNN generated objectives have superior dose sparing without compromising of target dose. It significantly reduced the planning time.

Feasibility of automatic IMRT planning for cervical cancer based on a database of previously-treated patients / 中华放射肿瘤学杂志

Objective@#To develop and evaluate an automatic intensity-modulated radiation therapy (IMRT) program for cervical cancer based on a database of overlap volume histogram (OVH) and high-quality cervical IMRT plans for previously-treated patients.@*Methods@#A database consisting of high-quality IMRT plans and OVHs from 200 cervical cancer patients was established. OVHs of another 26 cervical cancer patients were converted into gray level images to calculate the image similarity compared with those from the database. The planning optimization function of the patients from the database with the highest image similarity was selected and inherent Pinnacle3 scripts were utilized to automatically generate IMRT plan. Finally, the dosimetric parameters, plan quality and design time were statistically compared between the automatic and manual plans.@*Results@#The target coverage, conformity index and homogeneity index did not significantly differ between two plans (all P>0.05). The V40, V45 and mean dose for the rectum in the automatic plans were significantly decreased by 6.1%, 1.3% and 50.7 cGy than those in the manual plans (all P<0.05). Compared with the manual plans, the mean dose for the intestine and femur in the automatic plans were significantly reduced by 31.7 cGy and 188.9 cGy (both P<0.05), whereas the mean dose for the ilium was slightly decreased by 92.3 cGy in the automatic plans (P>0.05). The plan design time was shortened by 71% in the automatic plans.@*Conclusions@#The automatic IMRT plans based on a database of OVH and high-quality IMRT plans can not only significantly shorten the plan design time, but also reduce the irradiated dose of normal tissues without compromising the target coverage and conformity index.

Selenoprotein thioredoxin reductase mediated menadione reduction: catalytic properties & inhibition effects / 生物工程学报

Thioredoxin reductase (TrxR) is one class of the most important antioxidant selenoproteins and is involved in regulating tumor genesis and progression. It has been reported that naphthoquinones can target and inhibit TrxR1 activity therefore produce reactive oxygen species (ROS) mediated by TrxR1, resulting into cellular redox imbalance and making the naphthoquinone compounds to become potential antitumor chemotherapy drugs. The purpose of this work is to explore the interaction between TrxR1 and menadione using biochemical and mass-spectrometric (MS) analyses, to further reveal the detailed mechanisms of TrxR1-mediated naphthoquinone reduction and inhibition of TrxR1 by naphthoquinone compounds. Using the site-directed mutagenesis and recombinantly expressed TrxR1 variants, we measured the steady-state kinetic parameters of menadione reduction mediated by TrxR1 and its variants, performed the inhibition analysis of menadione on TrxR1 activity, and eventually identified the interaction between menadione and TrxR1 through MS analysis. We found that Sec-to-Cys mutation at residue of 498 significantly enhanced the efficiency of TrxR1-mediated menadione reduction, though the Sec⁴⁹⁸ is capable to catalyze the menadione reduction, indicating that TrxR1-mediated menadione reduction is dominantly in a Se-independent manner. Mutation experiments showed that Cys⁴⁹⁸ is mainly responsible for menadione catalysis in comparison to Cys⁴⁹⁷, while the N-terminal Cys⁶⁴ is slightly stronger than Cys⁵⁹ regarding the menadione reduction. LC-MS results detected that TrxR1 was arylated with one molecule of menadione, suggesting that menadione irreversibly modified the hyper-reactive Sec residue at the C-terminus of selenoprotein TrxR1. This study revealed that TrxR1 catalyzes the reduction of menadione in a Se-independent manner meanwhile its activity is irreversibly inhibited by menadione. Hereby it will be useful for the research and development of naphthoquinone anticancer drugs targeting TrxR1.

Observations on the effect of thunder-fire moxibustion with meridian point on deficiency of kidney and spleen, and blood stasis in chronic kidney diseases stage three / 中国实用护理杂志

Objective:To observe clinical effect of thunder-fire moxibustion with meridian point, including lumbar spinal cordacupoints of bladder meridian and abdominal acupoints of Ren channel, which treating on deficiency of kidney and spleen and blood stasis in chronic kidney diseases (CKD) stage 3.Methods:Totally 60 patients were randomly divided into treatment and control group. 30 patients in control were treated with blood pressure and lipid adjustment, Chinese medicine and nutritional therapy. 30 patients in treatment group were treated with thunder-fire moxibustion with meridian point based on control. A moxibustion-treated course has 2 weeks, patients were treated every other day. Observe blood urea nitrogen (Bun) , creatinine (Scr) , glomerular filtration rate (eGFR) , Chinese medicine syndrome and quantitative score, as well as clinical efficacy.Results:After 4 weeks of intervention, the TCM syndrome score [8 (4,10)] in the treatment group was significantly lower than that in the control group [12 (10,14)], with a statistically significant difference ( Z=-3.706, P = 0.000); in the quantitative score of symptom classification, the patients in the treatment group were significantly lower than those in the control group [2 (0,2)], chills [2 (2,2)], fatigue [2 (2,4)], the difference was statistically significant ( Z=-2.625, -3.593, -4.609, P < 0.01). The frequency of nocturia in the treatment group was significantly higher than that in the control group ( Z=-1.989, P < 0.05), while that in the treatment group was not significantly better than that in the control group ( P > 0.05). In terms of clinical efficacy, the total effective rate of the treatment group was 93.3% (28/30), which was better than73.3% (22/30) of the control group ( χ2= 38.19, P = 0.000). Conclusion:Thunder-fire moxibustion with meridian point improve deficiency of kidney and spleen and blood stasis of patients in CKD stage3, such as weak waist, cold chills, poor appetite, weakness and nocturia, as well as ameliorate renal function.

Feasibility of automatic IMRT planning for cervical cancer based on a database of previously-treated patients / 中华放射肿瘤学杂志

Objective To develop and evaluate an automatic intensity-modulated radiation therapy (IMRT) program for cervical cancer based on a database of overlap volume histogram (OVH) and high-quality cervical IMRT plans for previously-treated patients.Methods A database consisting of high-quality IMRT plans and OVHs from 200 cervical cancer patients was established.OVHs of another 26 cervical cancer patients were converted into gray level images to calculate the image similarity compared with those from the database.The planning optimization function of the patients from the database with the highest image similarity was selected and inherent Pinnacle3 scripts were utilized to automatically generate IMRT plan.Finally,the dosimetric parameters,plan quality and design time were statistically compared between the automatic and manual plans.Results The target coverage,conformity index and homogeneity index did not significantly differ between two plans (all P＞0.05).The V40,V45 and mean dose for the rectum in the automatic plans were significantly decreased by 6.1％,1.3％ and 50.7 cGy than those in the manual plans (all P＜0.05).Compared with the manual plans,the mean dose for the intestine and femur in the automatic plans were significantly reduced by 31.7 cGy and 188.9 cGy (both P＜0.05),whereas the mean dose for the ilium was slightly decreased by 92.3 cGy in the automatic plans (P＞ 0.05).The plan design time was shortened by 71％ in the automatic plans.Conclusions The automatic IMRT plans based on a database of OVH and high-quality IMRT plans can not only significantly shorten the plan design time,but also reduce the irradiated dose of normal tissues without compromising the target coverage and conformity index.

Observations on the effect of thunder-fire moxibustion with meridian point on deficiency of kidney and spleen, and blood stasis in chronic kidney diseases stage three / 中国实用护理杂志

Objective@#To observe clinical effect of thunder-fire moxibustion with meridian point, including lumbar spinal cordacupoints of bladder meridian and abdominal acupoints of Ren channel, which treating on deficiency of kidney and spleen and blood stasis in chronic kidney diseases (CKD) stage 3.@*Methods@#Totally 60 patients were randomly divided into treatment and control group. 30 patients in control were treated with blood pressure and lipid adjustment, Chinese medicine and nutritional therapy. 30 patients in treatment group were treated with thunder-fire moxibustion with meridian point based on control. A moxibustion-treated course has 2 weeks, patients were treated every other day. Observe blood urea nitrogen (Bun) , creatinine (Scr) , glomerular filtration rate (eGFR) , Chinese medicine syndrome and quantitative score, as well as clinical efficacy.@*Results@#After 4 weeks of intervention, the TCM syndrome score [8 (4,10)] in the treatment group was significantly lower than that in the control group [12 (10,14)], with a statistically significant difference (Z=-3.706, P = 0.000); in the quantitative score of symptom classification, the patients in the treatment group were significantly lower than those in the control group [2 (0,2)], chills [2 (2,2)], fatigue [2 (2,4)], the difference was statistically significant (Z=-2.625, -3.593, -4.609, P < 0.01). The frequency of nocturia in the treatment group was significantly higher than that in the control group (Z=-1.989, P < 0.05), while that in the treatment group was not significantly better than that in the control group (P > 0.05). In terms of clinical efficacy, the total effective rate of the treatment group was 93.3% (28/30), which was better than73.3% (22/30) of the control group (χ2= 38.19, P = 0.000).@*Conclusion@#Thunder-fire moxibustion with meridian point improve deficiency of kidney and spleen and blood stasis of patients in CKD stage3, such as weak waist, cold chills, poor appetite, weakness and nocturia, as well as ameliorate renal function.

Changes of CD4+CD25+ regulatory T cells and related regulatory factors in acute renal allograft rejection in rats / 中华肾脏病杂志

Objective To observe the level of CD4+CD25+ regulatory T cells (CD4+CD25+ Treg cells) with positive fork head transcription factor 3 (Foxp3) and changes of T-box transcription factor TBX1 (TBX1) and myocyte specific enhancer 2D (MEF2D) expression in peripheral blood of rats with acute rejection after renal transplantation,and to investigate its regulatory mechanisms by combined with renal function,plasma interleukin-10 (IL-10),interferon-γ (IFN-γ) and renal histopathological changes.Methods Rat renal transplantation model was established and divided into two groups:acute rejection group (AR group) and non-acute rejection group (non-AR group).Their renal function including serum creatinine (Scr) and blood urea nitrogen (BUN) in plasma was measured.The renal histopathology was observed by HE staining.Levels of IL-10 and IFN-γ in plasma were detected by ELISA.The proportion of CD4+CD25+ Treg cells was measured by flow cytometry.The mRNA expressions of Foxp3,TBX1 and MEF2D in CD4+CD4+Treg cells were detected by real-time PCR,and their protein expressions were tested by Western blotting.Results Compared with these in the non-AR group,the levels of BUN,Scr and IFN-γ significantly increased in AR group (all P ＜ 0.05),while IL-10 decreased (P ＜ 0.05).Renal histopathology in the acute rejection group showed glomerular hypertrophy and mesangial cell proliferation,capillary proliferation and neutrophil infiltration;renal interstitial edema and tubular necrosis,accompanied by lymphocytes,plasma cells and neutrophils infiltration.Compared with that in the non-AR group,the percentage of CD4+CD25+ Treg cells in peripheral blood was notably lowered in AR group (4.50％±0.50％ vs 5.74％±1.96％,P ＜ 0.05).The mRNA and protein expressions of Foxp3 and MEF2D were lower in AR group than those in non-AR group,while the expressions of TBX1 was elevated (all P ＜ 0.05).Conclusions In rats with acute renal allograft rejection,the percentage of CD4+CD25+ Treg cells and expressions of Foxp3,MEF2D and IL-10 decrease,while the expressions of TBX1 and IFN-γ enhance.These participate in the development of acute rejection after renal transplantation,and aggravate the renal damage.

An investigation of precision of full six-degree target shift corrections using the ArcCHECK system / 中华放射肿瘤学杂志

Objective To investigate the precision of full six-degree target shift corrections using the ArcCHECK system.Metbods Fourteen patients receiving intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) in Fujian Medical University Cancer Hospital from May to September,2015 were selected.The first treatment setup errors were obtained using cone-beam computed tomography.The setup errors were simulated in ArcCHECK,and the full six-degree target shift corrections was used to correct the errors.The plans without and with setup errors and the plan with corrected setup errors were taken.The paired t-test was used to compare dose to agreement (DTA) and Gamma passing rates between the plan without setup errors and the plan with setup errors and plan with corrected setup errors.Results The DTA and Gamma passing rates were (96.76± 1.57)％ and (98.35±0.92)％ for the plan without setup errors,(59± 21.42) ％ and (62.86± 21.63) ％ for the plan with setup errors,and (91.41± 4.82) ％ and (94.11±4.33)％ for the plan with corrected setup errors.There were significant differences between the plan without setup errors and the plan with setup errors and plan with corrected setup errors in DTA passing rate (t=6.64 and 5.13,both P＜0.05) and Gamma passing rate (t=6.15 and 4.19,both P＜0.05).Conclusions The full six-degree target shift corrections can be used in IMRT for NPC,with good results in correcting setup errors and improving the precision for IMRT dose distribution.

Dosimetric comparison of combined intracavitary/interstitial brachytherapy planning using three different kinds of optimization methods in locally advanced cervical cancer / 中华放射医学与防护杂志

Objective To compare and analyze the dosimetric discrepancy of combind intracavitary/interstitial brachytherapy using three different kinds of optimization method in locally advanced cervical cancer.Methods Totally 20 cases of locally advanced cervical cancer were selected and divided into three groups according to different optimization method which include manual optimization group (MO) based on graphical optimization,inverse planning simulated annealing (IPSA 1)based on simulated annealing optimization algorithm,IPSA 2 based on IPSA 1 with limitation on maximum dose of target.The dose volume histogram parameters of the targets (V200,V150,V100,D100,D90,HI) and the OARs(D0.1 cm3,D1 cm3 and D2 cm3) were analyzed.Results For CTV,compared with MO,there was no significantly statistical difference in D100between IPSA 1 and IPSA 2(P ＞ 0.05).However,V200,V150,V100 and HI for ISPA1 were better than for ISPA2 (t =-3.422-9.910,P ＜ 0.05).In addition,V100 and D100 in ISPA1 were better than in ISPA2 (t =7.238,5.032,P ＜0.05).For OARs,D0.1 cm3,D1 cm3 and D2 cm3 in rectum,bladder,sigmoid colon of both ISPA 1 and ISPA 2 were dramatically lower than those of MO (t =2.235 5.819,P ＜ 0.05),without significantly statistical difference found between ISPA1 and ISPA2.Conclusions For combined intracavitary/interstitial brachytherapy in locally advanced cervical cancer,all treatment plans based on three different kinds of optimization methods can meet the clinical need.Moreover,inverse optimization can ensure dose coverage over target and reduce maximum dose of rectum,bladder and sigmoid colon.

Some suggestions on standardized training of resident doctors in a primary hospital / 中国中西医结合急救杂志

Objective To explore the issues related to the standardized training of resident doctors at the primary hospital and provide basis for the standardization of doctors' training. Methods Questionnaires were used to investigate the resident titles, ages, and education background in the Huanxian People's Hospital. The self-assessment of the competency of resident doctors and professional contents necessary for their improvement were analyzed to identify the medical topics should be recommended to improve their clinical knowledge and techniques. Results Forty-six of 52 registered residents in the Huanxian People's Hospital participated in the survey with a participation rate of 88.5%. In this hospital, mainly the title of physicians was resident, accounting for 43.3% (52/120), the ages were chiefly in the range of 31 - 35 years, and their education levels were college degree 42.3% (22/52) and bachelor degree 48.1% (25/52). 76.1% (35/46) of the residents found they had difficulties in working and not competent enough on the present post, and 71.7% (33/46) of residents considered that they were in urgent need to strengthen their trainings of clinical thinking and clinical skills. Conclusions Strengthening the residents' self academic qualifications, improving the hospital teaching system, enhancing the teaching management, and focusing on clinical thinking and clinical skills training are the main issues in the current standardized training in primary hospitals. By accelerating the standardized training of residents, they may have the chance to transform to be the middle-level physicians and improve the unreasonable structure of doctor title distribution that will play the key role in the development of primary hospitals.

Investigation report on the effect of large hospital's group teaching in a hospital located in the remote area / 中国中西医结合急救杂志

Objective To evaluate the effectiveness of group teaching of Third Hospital of Peking University (Beijing Medical Third Hospital) for a hospital located in remote area. Methods From 2016 to 2017, 19 medical staff from Peking University Third Hospital gave their support to Huanxian People's Hospital and provided respectively the theoretical support, guidance of clinical skills, medical consultation, free paid clinic, outpatient service, and teaching rounds, etc. A questionnaire survey was carried out to realize the subjective evaluation of the 155 clinical front-line staff who had participated in the class regarding the effect of group teaching and the most welcome teaching mode and contents; the objective data on the monthly outpatient visits, number of patients admitted into the hospital, the number of surgical patients, etc were calculated and compared between the pre-support (2014 to 2015) and post-support (2016 to 2017) period to evaluate the effect of counterpart support. Results One hundred and fourteen of the 155 medical staff in their respective departments were trained by the experts, and the percentage of medical staff believed that the counterpart support helped clinical work very much accounting for [58.8% (67/114)] being significantly higher than those who considered of no help [9.6% (11/114)], a little help [16.7% (19/114)] and some help [14.9% (17/114), χ2= 94.082, P = 0.000]; after support, the number of monthly outpatient visits compared to that of pre-support period (case times:43 816.5±3 406.9 vs. 37 319.5±4 302.1) and the number of monthly patients hospitalized compared to that of pre-support period (case times: 2 978.3±235.1 vs. 2 250.9±218.1) were significantly higher than those before the support (all P < 0.05), no statistical significant difference in monthly surgery volume (case times: 449.8±107.3 vs. 459.0±85.4, P > 0.05) between the above 2 periods was seen. The survey showed that the mostly demanding teaching method was theoretical teaching [65.8% (102/155)], followed by teaching rounds [50.3% (78/155)] and outpatient teaching the least [18.1% (28/155)]. That the ratios of various teaching contents with their sequence from high to low the medical personnel required were as follows: to learn new technologies [76.8% (119/155)], medical frontier knowledge [68.4% (106/155)], and standard diagnosis and treatment manipulations [67.7% (105/155)], cultivation of clinical thinking [66.5% (103/155)] and passing on surgical skills [56.1% (87/155)]. There were statistical significant differences between each teaching method and teaching content (all P < 0.05). Conclusions Teaching to cultivate qualified health personnel is the key to the development of hospitals located in remote areas, according to their needs, combining local conditions and the establishment of long-term cooperation mechanisms, we can comprehensively improve the professional quality of medical personnel and the overall strength of hospitals located in remote areas.