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Objective To explore the association of (cardiometabolic index , CMI ) and ( lipid accumulation product , LAP ) with the prevalence of hypertension in adults in Pingshan District, Shenzhen, and to evaluate the predictive value of CMI and LAP for the prevalence of hypertension. Methods A cross-sectional survey was conducted, in which 1000 permanent residents aged 18-69 years in Pingshan District, Shenzhen were randomly selected as survey subjects. The data were collected using questionnaires, physical measurements and blood tests, and the relationship between CMI, LAP and hypertension prevalence was analyzed using logistic regression models. Results A total of 987 subjects were included in the analysis, including 471 (47.72%) males and 516 (52.28%) females, with an average age of 40.9 ± 11.1 years. Subjects of different genders were divided into groups Q1 to Q4 according to quartiles of CMI and LAP, and the prevalence of hypertension increased with increasing levels of CMI and LAP in both men and women (P for trend < 0.001). Logistic regression analysis revealed that after adjusting for variables such as age and occupation, the OR for hypertension was 1.251 (1.025-1.526) and 1.685 (1.001-2.836) for men and women, respectively, for each standard deviation increase in CMI; the OR for hypertension was 3.519 (1.343-9.222) for men in the Q4 group, compared to the CMI subgroup Q1. For each standard deviation increase in LAP, the ORs for hypertension were 1.355 (1.089-1.686) and 1.825 (1.023-3.254) for men and women, respectively; compared to LAP subgroup Q1, the ORs for hypertension in the male Q3 and Q4 groups were 2.554 (1.103-5.909) and 5.322 (2.393-11.834), while the OR for hypertension in the female Q4 group was 2.906 (1.096-7.703). ROC analysis revealed that the area under the curve (AUC) for CMI, LAP, and BMI was 0.671, 0.704, and 0.702 for males, and 0.660, 0.722, and 0.697 for females, respectively. The AUC for LAP was greater than that for CMI for different genders (P < 0.01). Conclusion The greater the CMI and LAP values in adults in Pingshan District, Shenzhen , the higher the prevalence of hypertension. CMI and LAP have certain values in predicting the prevalence of hypertension.
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Objective:To observe the changes in hippocampus (CA1) and study the effect of chronic intermittent hypobaric hypoxia (CIHH) preconditioning on the memory and cognitive function of mice exposed to the whole brain irradiation.Methods:A total of 48 C57BL/6 male mice were randomly divided into control group, CIHH group, irradiation group (IR group) and CIHH+ IR group. For IR group, the whole brain of mice were irradiated with 10 Gy of 6 MV X-rays in a single fraction. Pretreatment with CIHH was performed by placing mice in a hypobaric chamber before radiation. The mirrors water maze experiment was performed in the four groups to observe the escape latency, the number of crossing platforms and the target quadrant residence time. Nissl staining was used to observe the changes of neuronal cells in hippocampal CA1 region. Immunofluorescence was used to detect the expression of microtubule-associated protein cells (DCX) in the subgranular zone (SGZ) of hippocampal dentate gyrus (DG) to evaluate neurogenesis.Results:After 30 days of whole brain irradiation, the escape latency of mice prolonged gradually, the frequency of crossing platform decreased ( P< 0.001), and the exploration time in the target quadrant decreased ( P<0.001). X-ray irradiation caused disorder of mice neuronal cells, degeneration and necrosis of neuronal cells, and decrease of DCX expression in CA1 region of mice. Compared with IR group, the CIHH+ IR group had shortened the escape latency, increased the frequency of crossing platform [(2.08±0.26) vs. (0.83±0.24), P<0.001], and also increased the exploration time in the target quadrant [(14.12±0.82)s vs. (7.42±0.73)s, P<0.001]. Pretreatment with CIHH also alleviated the deformation and necrosis of neurons in hippocampus, and increased DCX expression in CA1 region. Conclusions:Pretreatment of mice with CIHH plays a protective role in radiation induced hippocampal injury.
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Objective:To evaluate the effect of inhaled aerosolized budesonide and salbutamol on lung function during one-lung ventilation (OLV) in rabbits.Methods:Thirty-two healthy male New Zealand white rabbits, aged 5-6 months, weighing 2.5-3.0 kg, were randomized into 4 groups ( n=8 each) using a random number table method: two-lung ventilation (TLV) group, OLV group, inhalation of aerosolized budesonide group (group B) and inhalation of aerosolized budesonide and salbutamol group (group B+ S). Bilateral lungs were ventilated for 3 h in group TLV, the left lung was ventilated for 2 h followed by 1-h TLV in OLV, B and B+ S groups, aerosolized budesonide 1 mg (diluted to 2 ml in normal saline) was inhaled before OLV in group B, and aerosolized salbutamol 0.15 mg/kg plus budesonide 0.5 mg was inhaled before OLV in group B+ S.The equal volume of aerosolized normal saline was delivered in TLV and OLV groups.Volume-controlled ventilation was used in all groups.Arterial blood samples were obtained for blood gas analysis before aerosol inhalation (T 0), 15 min and 1 h after aerosol inhalation (T 1, 2), and at the end of ventilation (T 3). Oxygenation index was calculated.Mixed venous blood samples were collected to determine the corresponding parameters.The pulmonary shunt (Qs/Qt) was calculated.Peak airway pressure (P peak), airway platform pressure (P plat), airway resistance (Raw), and lung compliance (C dyn) were continuously monitored and recorded at T 0-T 3. Results:Compared with group TLV, the concentration of lactic acid was significantly increased at T 2, 3, oxygenation index and C dyn were decreased at T 1-3, and Qs/Qt, Raw, P plat and P peak were increased in OLV, B and B+ S groups ( P<0.05). Compared with group OLV, the concentration of lactic acid was significantly decreased at T 2, 3, oxygenation index and C dyn were increased at T 1-3, and Qs/Qt, Raw, P plat and P peak were decreased in B and B+ S groups ( P<0.05). Compared with group BD, the C dyn was significantly increased at T 1-3, and Qs/Qt, Raw and P peak were decreased in group B+ S ( P<0.05). Conclusion:Inhaled aerosolized budesonide and salbutamol can effectively improve lung function during OLV in rabbits.
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At present,the heart has become an important organ at risk during radiotherapy for thoracic,mediastinal and breast carcinoma.Heart is relatively sensitive to radiation because of its anatomical location and structure.Long-term survival of patients have been affected by cardiac adverse effect postradiotherapy.In this paper,the progress of clinical manifestations,risk factors,screening methods,prevention and treatment of radiation-induced cardiac damage were reviewed as follows.
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At present, heart has become an important organ at risk during radiotherapy for thoracic, mediastinal and breast carcinoma. Heart is relatively sensitive to radiation because of its anatomical location and structure. The incidence of radiation-induced cardiac adverse events can affect the long-term survival of patients. In this article, the recent progress on the basic research of radiation-induced heart damage was described as follows.
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At present,heart has become an important organ at risk during radiotherapy for thoracic,mediastinal and breast carcinoma.Heart is relatively sensitive to radiation because of its anatomical location and structure.The incidence of radiation-induced cardiac adverse events can affect the long-term survival of patients.In this article,the recent progress on the basic research of radiation-induced heart damage was described as follows.
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Objective To analyze the clinical efficacy,toxicity and survival prognosis of patients diagnosed with Siewert type Ⅱ and Ⅲ locally advanced adenocarcinoma of esophagogastric junction (AEG) undergoing preoperative involved-field irradiation with concurrent chemotherapy. Methods A total of 45 cases were recruited in this prospective clinical trial. Prior to surgery, patients received 2 cycles of chemotherapy with XELOX and concurrent radiotherapy ( a total of 45 Gy in 25 fractions,5 times weekly). After 6-8 weeks,they underwent surgical resection. After the surgery,patients received 6 cycles of adjuvant chemotherapy. The completion of preoperative neoadjuvant chemoradiotherapy, postoperative pathological status,TNM down-staging effect and adverse reactions were observed. Kaplan-Meier method was applied to estimate survival analysis. Results All 45 patients completed preoperative neoadjuvant chemoradiotherapy. Among them, 39 patients completed 2 cycles of chemotherapy, and 6 patients completed 1 cycle of chemotherapy. The median time of surgical interval was 6 weeks. The R0resection rate was 96%.The pathological complete response (pCR) rate was 22%. The TNM down-staging rate was 69%.The incidence of acute radiation-induced esophagitis or gastritis was 44% and the incidence of radiation-induced pneumonitis was 7%. The incidence of grade 1-3 leukocytopenia,thrombocytopenia and neutropenia was 78%,47% and 44%,respectively. In terms of gastrointestinal reactions,the incidence of nausea,vomiting and loss of appetite was 62%,24% and 71%,respectively. No hematologic or nonhematologic adverse effects was observed at grade 4 or 5.The median follow-up time was 30 months. 11 patients died of cancer,1 patient was treatment-related death in the perioperative period and 1 patient died of pneumonia. The 1-,2-and 3-year progression-free survival (PFS) rates were 90%,70% and 67%,respectively. The 1-,2-and 3-year overall survival rates were 95%,80% and 75%,respectively. The 1-,2-and 3-year local control rates were 95%,84% and 84%, respectively. The 1-, 2-and 3-year distant metastasis rates were 7%, 25% and 25%, respectively. Conclusions Preoperative involved-field irradiation with concurrent chemotherapy yields relatively high clinical efficacy and is well tolerated by patients with Siewert typeⅡandⅢlocally advanced AEG.Patients are recommended to receive 4 cycles of adjuvant chemotherapy following neoadjuvant chemoradiotherapy and surgery.
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Objective To investigate whether pyrrolidine dithiocarbamate (PDTC) can attenuate the acute radiation-induced heart damage (RIHD) by inhibiting the activation of NF-κB and its downstream signaling pathways in rat models. Methods Twenty-one male adult Sprague-Dawley (SD) rats were randomly divided into the blank control, irradiation and PDTC plus irradiation groups (n=7 for each group). In the irradiation and PDTC+ irradiation groups,the rats received 6 MV X-ray at a single fraction of 20.0 Gy. In the PDTC+ irradiation group, intraperitonal injection of PDTC was administered at a dose of 120 mg/kg body weight,30 minutes prior to radiation, once daily for 1-14 days. On the 14thday,pathological changes of myocardial tissue were observed. Masson's trichrome staining was performed to calculate the collagen volume fraction (CVF) of myocardial cells. The expression levels of NF-κB family members including p50, p65,HIF-1α,connective tissue growth factor (CTGF) and collagen type 1(COL-1) proteins and mRNA were quantitatively measured by Western blot and quantitative real-time PCR (qPCR). Statistical analysis was conducted by using t-test. Results HE staining demonstrated that compared with the irradiation group, the severity of myocardial edema was alleviated,the infiltration of inflammatory cells was mitigated and the quantity of fibroblasts was reduced in the PDTC+irradiation group. Masson's trichrome staining revealed that PDCT intervention could decrease the deposition of collagen fiber in the interstitial tissues. Semi-quantitative analysis demonstrated that the CVF value in the PDTC+irradiation group was (9.99± 0.32)%, significantly lower compared with (22.05±0.21)% in the irradiation group (P<0.05). Western blot and qRT-PCR demonstrated that the expression levels of p50,p65,and HIF-1αproteins and mRNA in the PDTC+ irradiation group were significantly down-regulated compared with those in the irradiation group (all P<0.05). Compared with the irradiation group,the expression levels of CTGF protein and mRNA tended to decline (all P>0.05),and the expression levels of COL-1 protein and mRNA were equally inclined to decrease (P<0.05 and P>0.05). Conclusion PDTC can alleviate the acute RIHD by suppressing the activation of NF-κB and its downstream HIF-1α transcription.
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Objective To examine the pathological changes in the myocardial tissues such as inflammatory response and fibrosis in a rat model of acute radiation-induced heart damage (RIHD),and to explore whether NF-κB and its downstream pathway are associated with acute radiation-induced myocardial fibrosis.Methods Fourteen nale adult Sprague-Dawley rats were randomly divided into control group and radiation group.Local heart irradiation was delivered to the precordial region of rats to establish an RIHD model in a single fraction with a dose of 20 Gy generated by a 6 MV linear accelerator.At 14 days after irradiation,the histopathological changes in myocardial and interstitial tissues were examined by HE staining;the distribution of collagen fibers was observed by Masson staining,and collagen volume fraction (CVF) was used as a semi-quantitative evaluation for myocardial collagen deposition,which was defined as the percentage of collagen area occupied in total area,and was compared using the independent-samples t test.The protein and mRNA expression levels of the NF-κB members p50 and p65 and the downstream pathway members hypoxia-inducible factor 1α(HIF-1o),connective tissue growth factor (CTGF),and type I (COL-1) were quantitatively analyzed by Western blot and qPCR,respectively.Results At 14 days after local heart irradiation,the radiation group showed significant myocardial edema and derangement,rupturc of some myocardial ceils,mild nuclear pyknosis,darkened nuclear staining,a small number of irregular nuclei,and myocardial interstitial inflammatory cell infiltration accompanied by increased fibroblast,as compared with the control group.The Masson staining showed that the collagen fibers in radiation group were widely distributed at the interstitial tissue and increased significantly compared with those in the control group;normal myocardial cells were in disordered array and had a tendency to be replaced by collagen fibers.The semi-quantitative analysis showed that radiation induced a significant increase in CVF (22.05％ vs.3.76％,P =0.003).Western blot and qPCR revealed that the protein and mRNA expression of p50,p65,HIF-1 α,CTGF,and COL-1 was significantly higher in the radiation group than in the control group (all P ＜ 0.05).Conclusions The pathological features of acute RIHD include significant myocardial edema and myocardial interstitial inflammatory cell infiltration accompanied by increased fibroblasts and collagen fibers.Radiation exposure can activate NF-κB and cause the upregulation of HIF-1α and CTGF at both protein and mRNA levels,which may play an important role in the progression of radiation-induced myocardial inflammation to fibrosis.
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Objective To examine the effects of different pre-treatment nutritional status and inflammatory markers on acute adverse reactions in esophageal cancer patients during concurrent intensity-modulated radiation therapy (IMRT) and chemotherapy.Methods The acute adverse reactions of 338 eligible esophageal cancer patients who received concurrent IMRT and chemotherapy in our hospital from 2006 to 2014 were reviewed.The effects of different pre-treatment nutritional status, such as body mass index level (BMI), albumin level (ALB), total lymphocyte count (TLC), the presence or absence of anemia, and inflammatory indicators including neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR), on acute adverse reactions in the patients were examined.Data were analyzed using the chi-square test with continuity correction and logistic regression analysis.Results The incidence rate of malnutrition in the patients based on their nutritional status was 5.62%-54.14%.The incidence rate of grade≥2 acute radiation esophagitis (RE) was significantly higher in the low ALB group than in the normal ALB group (P=0.000).The incidence rate of adverse reactions in the hematologic system increased as TLC decreased (P=0.006), but the incidence rate of acute radiation pneumonitis (RP) was reduced as TLC decreased (P=0.001).In addition, the incidence rate of grade ≥2 acute RE was significantly higher in the anemia group than in the non-anemia group.Inflammatory marker analysis demonstrated that the incidence rate of acute RE was significantly higher in the high NLR group and high PLR group than in the low NLR group and low PLR group (P=0.000 and P=0.024, respectively).Logistic regression analysis of nutritional status and inflammatory markers showed that TLC was an independent risk factor for acute adverse reactions in the hematologic system (P=0.001), and ALB and PLR were independent risk factors for acute RE (P=0.017 and P=0.011,respectively).Conclusions Nutritional status and inflammatory markers are associated with concurrent chemoradiotherapy-induced acute adverse reactions in esophageal carcinoma patients, and hence may be valuable indicators of acute adverse reactions during treatment.In addition, nutritional treatment and support care should be actively provided to the patients to prevent the development of acute adverse reactions during treatment.
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Objective To investigate the pathological manifestations of acute?stage radioactive myocardial damage and related mechanisms using an experimental animal model. Methods A total of 12 adult male Sprague?Dawley rats were randomly divided into control group and radiation group. In the radiation group, the model of radiation?induced myocardial damage was established by the irradiation of the anterior myocardial territory with 6?MV X?ray at a single dose of 20 Gy, and at 14 days after irradiation, HE staining was used to observe the morphological changes of cardiomyocytes and intercellular matrix, and Masson staining was used to observe the distribution of collagen fibers. The collagen volume fraction ( CVF) was used for semi?quantitative analysis. ELISA was used to measure the activity of total superoxide dismutase ( T?SOD) and the concentration of malondialdehyde ( MDA ) , and Western blot was used to measure the expression of the fibrosis marker protein collagen type I ( COL?1 ) and the endoplasmic reticulum stress?related proteins GRP78 and CHOP. The t?test, t ’?test, or nonparametric rank sum test was used for comparison between groups. Results At 14 days after local irradiation of the heart, the radiation group had disordered arrangement of cardiomyocytes, marked edema, rupture of some cardiomyocytes, mild karyopyknosis in cardiomyocytes, and infiltration of inflammatory cells in the myocardial interstitium, compared with the control group. Collagen fibers in the myocardial tissue were mainly distributed in the perivascular area and cardiomyocyte interstitium. The radiation group had a significantly higher CVF than the control group ( 11?35% vs. 5?23%, P=0?000 ) and a significant increase in the expression of COL?1 compared with the control group ( P=0?000) . The radiation group had significant increases in the activity of T?SOD and the concentration of MDA in the myocardial tissue compared with the control group ( T?SOD:156?61 U/mgprot vs. 137?06 U/mgprot, P= 0?042;MDA:2?36 nmol/mgprot vs. 1?31 U/mgprot, P=0?007) . Compared with the control group, the radiation group showed significant increases in the expression of endoplasmic reticulum stress?related proteins GRP 7 8 and CHOP ( P= 0?037 and 0?009 ) . Conclusions The pathological manifestations of acute?stage myocardial damage include degeneration of cardiomyocytes, inflammatory exudation in the interstitium, and deposition of collagen in the perivascular area and myocardial interstitium. Myocardial fibrosis can be observed in the acute stage of radiation?induced myocardial damage, and the mechanism may be related to oxidative stress and endoplasmic reticulum stress induced by radioactive rays.
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The Medline and CNKI databases were searched with the key words of radiation-induced myocardial damage,damage pathway,pathogenesis,and intervention,and 37 articles were obtained.The pathogenesis of radiation-induced myocardial damage may be related to various mechanisms such as oxidative stress,transforming growth factor-β,renin-angiotensin system,mast cells,and endothelial dysfunction.The pathogenesis of radiation-induced myocardial damage is a complex process involving various mechanisms,and currently,there are ongoing studies on the cellular and molecular mechanisms involved in its pathogenesis and interventions.
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Objective To observe myocardial tolerance to ischemia/reperfusion (I/R) injury in rats after exposure to X-ray irradiation.Methods Twelve male rats were randomly divided into control group and radiation group.The rat model of radiation-induced heart disease was established in the radiation group by precordial irradiation with 20.0 Gy of 6 MV X-ray in a single fraction.At 14 days after model establishment,the Langendorff perfusion technique was performed in the two groups and the cardiac parameters including left ventricular developing pressure (LVDP),left ventricular end diastolic pressure (LVEDP),maximal rate of left ventricular pressure rise/fall (+/-LVdp/dtmax),and coronary flow (CF)were recorded.Myocardial infarct size after I/R was compared between the two groups by 2,3,5-triphenyltetrazolium chloride staining.Results After 30 minutes of ischemia and 60 minutes of reperfusion,the irradiation group had a significantly slower CF than the control group (5.64±0.35 vs.8.38±0.52 ml/min,P=0.002).Moreover,the irradiation group had substantially poorer recovery of cardiac function in isolated hearts compared with the control group,as shown by a significantly reduced LVDP (25.4±2.31 vs.52.76±2.76 mm Hg(1 mm Hg=0.133 kPa),P=0.000),significantly reduced+/-LVdp/dtmax(547.04±78.74 vs.1 100.05±83.35 mm Hg(1 mm Hg=0.133 kPa)/s,P=0.001;-408.81±56.74 vs-813.62±73.82mm Hg(1 mm Hg =0.133 kPa)/s,P=0.002),and a significantly increased LVEDP (85.29±4.61 vs.65.65±3.65 mm Hg (1 mm Hg =0.133 kPa),P=0.012).X-ray irradiation induced a significantly increased percentage of myocardial infarct size in rats (44.67％±0.95％ vs.30.46％±0.96％,P=0.000).Conclusions X-ray irradiation can induce coronary injury,reduce myocardial tolerance to I/R injury,and increase myocardial infarct size after I/R in rats.
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Objective To analyze the patterns and distribution of lymph node metastasis in patients with adenocarcinoma of the esophagogastric junction ( AEG). Methods The pathological data of 393 patients with AEG from 2006 to 2009 were analyzed. The patterns and distribution of lymph node metastasis were analyzed in patients with different Siewert subtypes, depths of tumor invasion, and maximum diameters of the tumor, and the high?risk lymphatic drainage areas were investigated. Between?group comparison was performed by χ2 test. Results The metastatic rate and ratio of abdominal lymph nodes in AEG were 69?? 2%and 31?? 31%, respectively. The incidence rates of lymph node metastasis in the cardia, lesser curvature, left gastric artery, splenic artery, splenic hilum, mesenteric root, and abdominal aorta were the highest. The metastatic rate and ratio of mediastinal lymph nodes were 16?? 4% and 8?? 3%, respectively. The incidence rates of lymph node metastasis in the lower paraesophageal, esophageal hiatus, and superior diaphragmatic areas were the highest. Compared with Siewert type II and type III AEG, Siewert type I AEG had a significantly higher mediastinal lymph node metastatic rate (P= 0?? 003) and a significantly lower abdominal lymph node metastatic ratio (P= 0?? 002).The metastatic ratios of lymph nodes in multiple abdominal regions were higher in patients with stage T3+T4 AEG and a maximum tumor diameter of ≥6 cm than in the control group, while the metastatic ratios of mediastinal lymph nodes in groups with different maximum tumor diameters were similar. The metastatic ratios of lymph nodes in the greater curvature, hepatoduodenal ligament, and inferior diaphragmatic areas were lower than 10% in all groups. Conclusions In radiotherapy for AEG, the abdominal high?risk lymphatic drainage areas involve the cardia, lesser curvature, left gastric artery, splenic artery, splenic hilum, mesenteric root, and abdominal aorta, while the mediastinal high?risk lymphatic drainage areas involve the lower paraesophageal, esophageal hiatus, and superior diaphragmatic areas. In addition, the personalized target volume design should be based on the patterns of lymph node metastasis with different Siewert subtypes and clinical pathological characteristics.