Research on informatization construction of Type3 international emergency medical team / 中华医学教育探索杂志

This paper introduces the informatization construction of the world's first non-military Type 3 international emergency medical team (EMT Type3), which was established by West China Hospital of Sichuan University. Based on the requirements of World Health Organization (WHO) for EMT, the team built a complete information-based emergency rescue platform from the network layout, the design of software and hardware facilities and other aspects, combined with their own circumstance, which has improved the communication ability effectively, and has passed the expert certification of the WHO smoothly.

Connexin 40-formed GJIC increases the phototoxicity of photodynamic therapy through ROS- and calcium-mediated pathways / 中国药理学与毒理学杂志

OBJECTIVE To explore the effect of connexin (Cx) 40-formed gap junctional intercellular communication (GJIC) on Photofrin- photodynamic therapy (PDT) phototoxicity in Cx40- transfected HeLa cells and its potential mechanisms. METHODS HeLa cell line stably transfected to express Cx40 was seeded at high and low cell density, respectively, to assess in vitro photosensitivity using CCK8 assay. Western blot assay was performed to detect the expression of Cx40. The intracellular ROS and Ca2 +concentrations were determined using flow cytometer. 4-HNE and ceramide were measured using ELISA assay. RESULTS Cx40-composed GJ formation at high density enhances the phototoxicity of Photofrin-PDT. When the Cx40 is not expressed or Cx40 channels are blocked, the phototoxicity in high-density cultures substantially reduces, indicating that the enhanced PDT phototoxicity at high density is mediated by Cx40-composed GJIC. The GJIC-mediated increase in PDT phototoxicity was associated with ROS and calcium-mediated stress signaling pathways. CONCLUSION The work uniquely presents the ability of Cx40-composed GJIC to enhance the sensitivity of malignant cells to PDT, and indicates that mainte?nance or increase of Cx40-formed GJIC may be a profitable strategy towards the enhancement of PDT therapeutic efficiency.

Aerosolized iloprost therapy for pulmonary hypertensive crisis in 4 patients with idiopathic pulmonary arterial hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>To summary the efficacy and safety of aerosolized iloprost in patients with pulmonary hypertensive crisis.</p><p><b>METHODS</b>On the basis of conventional therapy, aerosolized iloprost (10 µg per time for 10 - 15 min in 2 hours interval, 8 times per day) was administered to four patients with idiopathic pulmonary arterial hypertension and pulmonary hypertensive crisis. Blood pressure, heart rate, systemic artery oxygen saturation, systolic pulmonary arterial pressure (sPAP) measured by echocardiography and the adverse events were analyzed.</p><p><b>RESULTS</b>After aerosolized iloprost therapy, sPAP was significantly decreased and systemic artery oxygen saturation was improved. Adverse events (nausea, vomiting, diarrhea, dry cough) were observed in two patients, and the iloprost use was stopped in one patient due to severe vomiting and diarrhea.</p><p><b>CONCLUSION</b>Aerosolized iloprost could significantly reduce the sPAP and improve the systemic artery oxygen saturation in patients with pulmonary hypertension crisis.</p>

Etiology and antimicrobial resistance of community-acquired pneumonia in adult patients in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Appropriate antimicrobial therapy of community-acquired pneumonia (CAP) is mainly based on the distribution of etiology and antimicrobial resistance of major pathogens. We performed a prospective observational study of adult with CAP in 36 hospitals in China.</p><p><b>METHODS</b>Etiological pathogens were isolated in each of the centers, and all of the isolated pathogens were sent to Zhongshan Hospital for antimicrobial susceptibility tests using agar dilution.</p><p><b>RESULTS</b>A total of 593 patients were enrolled in this study, and 242 strains of bacteria were isolated from 225 patients. Streptococcus pneumoniae (79/242, 32.6%) was the most frequently isolated pathogen, followed by Haemophilus influenzae (55/242, 22.7%) and Klebsiella pneumoniae (25/242, 10.3%). Totally 527 patients underwent serological tests for atypical pathogens; Mycoplasma pneumoniae and Chlamydia pneumoniae infections were identified in 205 (38.9%) and 60 (11.4%) patients respectively. Legionella pneumophila infections were identified in 4.0% (13/324) of patients. The non-susceptibility rate of isolated Streptococcus pneumoniae to erythromycin and penicillin was 63.2% and 19.1% respectively. Six patients died from the disease, the 30-day mortality rate was 1.1% (6/533).</p><p><b>CONCLUSIONS</b>The top three bacteria responsible for CAP in Chinese adults were Streptococcus pneumonia, Haemophilus influenza and Klebsiella pneumonia. There was also a high prevalence of atypical pathogens and mixed pathogens. The resistance rates of the major isolated pathogens were relatively low except for the high prevalence of macrolide resistance in Streptococcus pneumoniae.</p>

Evaluation of jaws-only intensity-modulated radiation therapy for nasopharyngeal carcinoma / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the feasibility and efficiency of jaws-only intensity-modulated radiation therapy (JO-IMRT) in treatment of nasopharyngeal carcinoma (NPC) using direct aperture optimization (DAO) technique and the independent jaws of linear accelerator.</p><p><b>METHODS</b>Both JO-IMRT and MLC-IMRT were planed in 10 NPC cases. The differences in the target coverage and dose uniformity, as well as the total monitor units and delivery times of the two IMRT plans were compared.</p><p><b>RESULTS</b>All the tested plans met the clinical requirement of the designed simplified IMRT (sIMRT). The conformal index (CI) of JO-IMRT and MLC-IMRT were 0.941±0.015 and 0.981±0.013, respectively (P<0.001), showing a minor superiority of MLC-IMRT. While controlling the total segment numbers to approach the limitation of sIMRT, the two therapies showed a total MU of 474.3 and 419.6 (P<0.05) with delivery times of 8.0 and 7.5 min (P<0.01), respectively. The efficiency of JO-IMRT was slightly lower than that of MLC-IMRT.</p><p><b>CONCLUSION</b>JO-IMRT can meet the sIMRT requirement in NPC treatment, and is feasible as an alternative treatment modality for the centers not equipped with MLC in their accelerators.</p>

Resolutions of high superficial dose in intensity-modulated radiation therapy when the target area is close to the surface / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the impact of different planning target volume (PTV) margin settings on surface and superficial dose distribution and explore the resolution of high superficial dose when the target area is close to the surface during head and neck intensity-modulated radiotherapy (IMRT).</p><p><b>METHODS</b>A typical superficial target volume was designed in an circular neck phantom. Two experimental inverse IMRT plans were conducted with 8MV X ray, and in plan A, the superficial side of PTV margin ranged from 0 to 5 mm, while other side margins were 5 mm; in plan B, an suppositional machine dosimetry data for IMRT optimization was established in which the build-up dose was eliminated, and this machine data was used to optimize the inverse IMRT plan followed by recalculation of the planned dose distribution with the actual clinical machine dosimetry data. The variation of the surface and superficial dose resulting from set-up error and the dose distribution to CTV were compared. The adequate PTV margin was analyzed when the CTV approached the surface.</p><p><b>RESULTS</b>In plan A, the high dose greater than the prescribed dose was found in the surface and superficial region when the superficial sparing distance was between the surface and PTV d<3 mm, and the 3 mm set-up margin increased this superficial dose remarkably. Reducing the superficial side of PTV margin lowered the high superficial dose effectively and allowed maintenance of the prescribed dose to the CTV. To avoid reduction of the dose to the CTV to below 95% of the prescribed dose, the superficial side of PTV margin should be greater than 1 mm. Plan B effectively lowered the surface doses and maintained the prescribed dose to the CTV.</p><p><b>CONCLUSIONS</b>With appropriate techniques for optimizing inverse IMRT, more homogeneous superficial dose can be achieved.</p>

Independent verification of monitor unit calculation for radiation treatment planning system / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>To ensure the accuracy of dose calculation for radiation treatment plans is an important part of quality assurance (QA) procedures for radiotherapy. This study evaluated the Monitor Units (MU) calculation accuracy of a third-party QA software and a 3-dimensional treatment planning system (3D TPS), to investigate the feasibility and reliability of independent verification for radiation treatment planning.</p><p><b>METHODS</b>Test plans in a homogenous phantom were designed with 3-D TPS, according to the International Atomic Energy Agency (IAEA) Technical Report No. 430, including open, blocked, wedge, and multileaf collimator (MLC) fields. Test plans were delivered and measured in the phantom. The delivered doses were input to the QA software and the independent calculated MUs were compared with delivery. All test plans were verified with independent calculation and phantom measurements separately, and the differences of the two kinds of verification were then compared.</p><p><b>RESULTS</b>The deviation of the independent calculation to the measurements was (0.1 +/- 0.9)%, the biggest difference fell onto the plans that used block and wedge fields (2.0%). The mean MU difference between the TPS and the QA software was (0.6 +/- 1.0)%, ranging from -0.8% to 2.8%. The deviation in dose of the TPS calculation compared to the measurements was (-0.2 +/- 1.7)%, ranging from -3.9% to 2.9%.</p><p><b>CONCLUSIONS</b>MU accuracy of the third-party QA software is clinically acceptable. Similar results were achieved with the independent calculations and the phantom measurements for all test plans. The tested independent calculation software can be used as an efficient tool for TPS plan verification.</p>

The angular dependence of a 2-dimensional diode array and the feasibility of its application in verifying the composite dose distribution of intensity-modulated radiation therapy / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>The planning dose distribution of intensity-modulated radiation therapy (IMRT) has to be verified before clinical implementation. The commonly used verification method is to measure the beam fluency at 0 degree gantry angle with a 2-dimensional (2D) detector array, but not the composite dose distribution of the real delivery in the planned gantry angles. This study was to investigate the angular dependence of a 2D diode array (2D array) and the feasibility of using it to verify the composite dose distribution of IMRT.</p><p><b>METHODS</b>Angular response of the central detector in the 2D array was measured for 6 MV X-ray, 10 cmx10 cm field and 100 cm source axis distance (SAD) in different depths. With the beam incidence angle of 0-60 degrees, at intervals of 10 degrees, and inherent buildup of the 2D array (2 g/cm2), the array was irradiated and the readings of the central diode were compared with the measurement of thimble ionization chamber. Using a combined 30 cmx30 cmx30 cm phantom which consisted of solid water slabs on top and underlying the 2D array, with the diode detectors placed at 8 g/cm2 depth, measurements were taken for beam angles of 0 degrees-180 degrees at intervals of 10 degrees and compared with the calculation of treatment planning system (TPS) that pre-verified with ion chamber measuring.</p><p><b>RESULTS</b>Differences between the array detector and thimble chamber measurements were greater than 1% and 3.5% when the beam angle was larger than 30 degrees and 60 degrees, respectively. The measurements in the combined phantom were different from the calculation as high as 20% for 90 degrees beam angle, 2% at 90 degrees+/-5 degrees and less than 1% for all the other beam angles.</p><p><b>CONCLUSIONS</b>The 2D diode array is capable of being used in composite dose verification of IMRT when the beam angles of 90 degrees+/-5 degrees and 270 degrees+/-5 degrees are avoided.</p>

Renin-angiotensin system blocking agents reverse the myocardial hypertrophy in experimental hyperthyroid cardiomyopathy via altering intracellular calcium handling / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the mechanisms of myocardial hypertrophy induced by Levothyroxine (L-Thy).</p><p><b>METHODS</b>A rabbit model of hyperthyroidism was established by daily intraperitoneal injections of L-Thy (45 microg/kg per day) for 28 days. New Zealand rabbits were randomly divided into four groups (n = 10 each): control group, L-Thy group (L-Thy alone), imidapril group (L-Thy + 0.5 mg/kg imidapril), and valsartan group (L-Thy + 8 mg/kg valsartan). All rabbits were treated for 4 weeks. At the end of the treatments, all rabbits underwent echocardiography and IVS, LV and LVPW thickness were measured. Ventricular tissues were then collected.Cardiac hypertrophy index, cardiomyocyte diameter, structural and ultrastructural changes were obtained. Ventricular myocytes were isolated by enzymatic digestion method and intracellular Ca2+ concentration was determined with the fluorescent Ca2+ indicator Fluo3/AM and laser scanning confocal microscopy. Activity of Sarco/Endoplasmic reticulum Ca2+ ATPase (SERCA) was evaluated with P-NPP method.mRNA expression of L-type Ca2+ channel (LCC), ryanodine receptor (RyR), and SERCA was semi-quantified with RT-PCR. Protein of IP3R was localized by immunostaining and semi-quantified with pathological image analytic system.</p><p><b>RESULTS</b>Compared with control group, rabbits treated with L-Thy displayed remarkable myocardial hypertrophy and morphological changes in both structure and ultrastructure levels. Increased intracellular Ca2+ concentration [(576.2 +/- 41.7) nmol/L vs. (314.6 +/- 35.6) nmol/L, P < 0.01] and decreased SERCA activity [(0.062 +/- 0.013) micromol x min(-1)xg(-1) vs. (0.133 +/- 0.022) micromol x min(-1)xg(-1), P < 0.01] were detected in L-Thy treated rabbits. RT-PCR analysis and (or) immunohistochemistry revealed decreased mRNA expression of LCC mRNA (0.48 +/- 0.11 vs. 0.75 +/- 0.16, P < 0.01) and increased RyR mRNA (1.19 +/- 0.21 vs. 0.73 +/- 0.15, P < 0.01), SERCA mRNA (1.01 +/- 0.08 vs. 0.76 +/- 0.09, P < 0.01) and IP3R protein (65.3 +/- 13.7 vs. 47.9 +/- 10.2, P < 0.01) expression in L-Thy treated rabbits. Both imidapril and valsartan could significantly attenuate cardiomyocyte hypertrophy and structural remodeling induced by L-Thy. Compared with L-Thy group, decreased intracellular Ca(2+) concentration [(376.4 +/- 32.5) nmol/L vs. (576.2 +/- 41.7) nmol/L, P < 0.01 and (392.6 +/- 41.2) nmol/L vs. (576.2 +/- 41.7) nmol/L, P < 0.01, respectively], and increased LCC mRNA (0.68 +/- 0.14 vs. 0.48 +/- 0.11, P < 0.01; 0.64 +/- 0.13 vs. 0.48 +/- 0.11, P < 0.01, respectively) and SERCA activity [(0.115 +/- 0.019) micromol x min(-1)xg(-1) vs. (0.062 +/- 0.013) micromol x min(-1)xg(-1), P < 0.01; (0.109 +/- 0.015) micromol x min(-1)xg(-1) vs. (0.062 +/- 0.013) micromol x min(-1)xg(-1), P < 0.01, respectively] were found in both imidapril and valsartan treated rabbits, but expression of RyR, SERCA and IP3R remained unchanged.</p><p><b>CONCLUSION</b>Intracellular Ca(2+) overload may play important roles in myocardial hypertrophy induced by L-Thy. Imidapril and valsartan may exert beneficial effects on hyperthyroid myocardial hypertrophy via altering intracellular calcium handling.</p>

Effect of smoking cessation on airway inflammation of rats with chronic bronchitis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Smoking is the major cause of airway inflammation in chronic obstructive pulmonary disease (COPD), and smoking cessation is regarded as one of the important strategies for prevention and treatment of the inflammation. The inflammation of the chronic airway may be present and deteriorated even if the COPD patients stop smoking. Whether and how early smoking cessation affects the progress of inflammation is still obscure. This study was conducted to find the appropriate time for smoking cessation to terminate the airway inflammation in rats with smoke-induced chronic bronchitis.</p><p><b>METHODS</b>A rat model of COPD was established by passively inhaling smoke mixture. Fifty-four young male Sprague-Dawley rats were randomly divided into 9 groups with different periods of smoke exposure and different time points of cessation. The inflammation markers to be detected included inflammatory cells in the bronchoalveolar lavage fluid (BALF), the myeloperoxidose (MPO) activity, the morphologic changes and the expression of ICAM-1 on the airway epithelium.</p><p><b>RESULTS</b>When smoking was terminated at early stage, the inflammatory markers and related indexes were different from those of the typical chronic bronchitis group (group M7) (P < 0.01). The pathologic score of group SC7 (2 weeks of smoking cessation after occurrence of typical chronic bronchitis) was not different from that of group M7, and the level of ICAM-1 was still up-regulated (compared to group M7, P > 0.05). Meanwhile, most of inflammatory cells in BALF were neutrophils compared to other groups (P < 0.01). When smoking was terminated, the MPO activity was significantly lower than that of group M7 (P < 0.01).</p><p><b>CONCLUSIONS</b>Smoking cessation at early stage can effectively inhibit the inflammatory reaction of COPD. Once chronic bronchitis occurs, little could be improved by smoking cessation.</p>

Expression of cellular phenotype switching markers-matrix protein Gla, mRNA and collagen I, III and V of human airway smooth muscle cells in vitro after TGF-beta1 stimulation / 中华儿科杂志

<p><b>OBJECTIVE</b>Bronchial asthma is a chronic inflammatory disorder. Long-term inflammation leads to varying degrees of structural changes in the airway wall known as airway reconstruction or remodeling. These structural changes are found in the airways of most patients with prolonged disease. After remodeling, the airway walls show the submucous membrane becomes thick with collagen deposition, and the smooth muscle cells show hyperplasia and hypertrophy. Smooth muscle cells are a vital component of the airway wall, and a major effector cell involved in the course of bronchial contraction. Smooth muscle cell hyperplasia and hypertrophy are important pathological changes in airway remodeling. This study investigated the expression of markers of human airway smooth muscle cells (ASMCs) phenotypic change, which were matrix Gla protein (MGP) and major fibrosis proteins, after in vitro treatment with transforming growth factor-beta(1) (TGF-beta(1)).</p><p><b>METHODS</b>Human ASMCs were subjected to primary culture in vitro. Ten groups of cells were treated with 100 microg/ml of TGF-beta(1), while the cells in the control groups were treated with 10% fetal bovine serum. After being cultured for 7 d, the cells of both groups were harvested. MGP mRNA expression was detected by RT-PCR. Protein levels of collagen I, III and V were determined by Western blot analysis.</p><p><b>RESULTS</b>Treated with TGF-beta(1), airway smooth muscle cells expressed MGP mRNA greater than controls [(62.3 +/- 13.1)% vs (27.4 +/- 11.4)%, P < 0.01]. Also, airway smooth muscle cells stimulated by TGF-beta(1) produced more collagen I, III and V than the control group (P < 0.01).</p><p><b>CONCLUSIONS</b>TGF-beta(1) induced expression of collagen III and V, which are early markers of the switch from a contractile to a synthetic phenotype in ASMCs. This induction is an indication that ASMCs have the potential to make this switch and that TGF-beta(1) is involved in airway remodeling.</p>

Strengthening the Construction of Functional Laboratory via Education Evaluation / 中华医学教育探索杂志

The aim of laboratory evaluation of basic education is to improve the quality of experimental teaching,which demands thorough reforms of many aspects,including the ranks of teachers,administration,content,methods and instrument of teaching. This article summarizes the experience and achievement of Functional Laboratory Centre,Central South University during under- graduate teaching evaluation by the Ministry of Education in 2006.

Dosimetric verification of a commercial three-dimension treatment planning system / 中华放射肿瘤学杂志

Objective Objective To verify the accuracy of dose calculation and the precision of beam modeling in a Pinnacle three-dimension treatment planning system(TPS).Methods Based on the photon beam model data of a Varian 600C Linac,output factor verification and 12 tests were carried out ac- cording to the recommendation of Netherlands Commission on Radiation Dosimetry(NCS).The results of ion chamber measurement and TPS calculation at selected points were compared.Deviation and confidence limit were used to evaluate dose calculation accuracy.Results The Pinnacle TPS had a high precision of dose calculation when compared with the measurement data.Deviation of calculated output factors was＜1% on all opening patrols,and was＜3% on wedged portal except one with the size of 15 cm?40 cm and angled 60?.The results of 12 tests were in accordance with the criteria of NCS recommendation,with maximum av- erage deviation＜1%.The overall accuracy is better than those of other TPS reported in the literature. Conclusions Dose verification is a prerequisite before a three-dimension treatment planning system is used in the clinical practice.Pinnacle treatment planning system installed in our institute is reasonably acceptable and satisfactory.

Intensity modulated radiation therapy for 122 patients with untreated nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective To analyse the preliminary clinical results of intensity modulated radiation therapy (IMRT) for 122 untreated nasopharyngeal carcinoma (NPC)pafients.Methods 122 NPC pa- tients received IMRT alone from Feb.2001 to Jun.2004,with 31 females and 91 males,and a median age of 45 years(range 25-66).According to the Fuzhou Stage Classification,there were StageⅠ11 patients, StageⅡ34,StageⅢ62,and StageⅣa 15.IMRT was carried out using an inverse planning system (COR- VUS 5.0,Peacock plan) developed by the NOMOS Corp.The treatment was given with the Multi-leaf Inten- sity Modulating Collimator (MIMIC) using a slice-by-slice arc rotation approach.The prescription dose was 68 Gy/30f to the nasopharynx gross tumor volume (GTV_(nx)),60-66 Gy/30f to positive neck lymph nodes (GTV_(nd)),60 Gy/30f to the first clinical target volume (CTV_1) and 54 Gy/30f to the second clinical target volume (CTV_2).Kaplan-Meier method was used to calculate the overall survival rate (OS),distant metas- tasis-free survival rates (DMFS),and local-regional control rates from the last date of therapy.Log-rank test was used to detect the difference between groups.Results The median follow-up time was 20 months ( range 6 to46 months).The 1-,2-,and 3-year OS was 95.2%,91.4%,85.1%,DMFS was 91.9%, 88.6%,85.6%,and the local-regional control rates was 96.5%,93.2%,93.2%,respectively.Statistics of the local control rate was insignificant either for advanced T(T3+T4) stage or early T(T1+T2) stage diseases(P=0.148).The 2-year regional control rate was insignificant either for patients with N(+) or N (-),but the 2-year DMFS was significant both for patients with N(+) and N(-)lesions(P=0.004).For 17 patients who failed,there were two with residual disease and one with recurrence at the primary site (17.6%),three patients in the neck (17.6%),twelve patients (70.6%) in distant metastases.Conclu- sions Intensity modulated radiation therapy does provide excellent local-regional control for untreated NPC, especially in patients with advanced T stage or N(+) lesion.Distant metastasis is the main cause of failure. N (+) is significantly correlated with distant metastasis.

A heterozygous point mutation G13328A in antithrombin gene causes thrombosis / 中华血液学杂志

<p><b>OBJECTIVE</b>To identify the phenotype and the gene mutation in a kindred with antithrombin (AT) deficiency.</p><p><b>METHODS</b>Immuno-nephelometry and chromogenic assay were used to detect the plasma level of AT antigen (AT: Ag) and activity (AT: A), respectively. All the seven exons and intron-exon boundaries of AT gene from the propositus were amplified by PCR and direct sequencing of the PCR pro-ducts was performed. Corresponding PCR fragments from the kindred were also sequenced directly. Megaprimer method was used to construct the mutant AT cDNA expressing vector from normal plasmid pCRII AT cDNA. The normal and mutant AT plasmid were transiently transfected into Cos-7 cells and AT: Ag was detected in supernatant and lysate of transfected cell with ELISA.</p><p><b>RESULTS</b>The plasma level of AT: Ag and AT: A for the propositus were 179 mg/L and 42.3%, respectively. A heterozygous G13328A missense mutation in exon 6 was identified, which led to the substitution of Thr (ACC) 404 for Ala (GCC). The sequencing results from the pedigree suggested that three other members also had the mutation. The level of AT:Ag in supernatant and lysate from cells transfected with mutant AT cDNA was 40% and 68% of that of normal AT cDNA transfected cells.</p><p><b>CONCLUSION</b>This is an unreported AT gene mutation in China, which causes type I hereditary antithrombin deficiency and thrombosis in the proposita.</p>

Genetic polymorphism in matrix metalloproteinase-9 and the susceptibility to chronic obstructive pulmonary disease in Han population of south China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are many candidate genes for chronic obstructive pulmonary disease (COPD). Matrix metalloproteinase-9 (MMP-9) plays an essential role in tissue remodeling and repair associated with development of COPD. In this study we investigated the correlation between MMP-9 gene polymorphism and COPD susceptibility in the Han population of South China.</p><p><b>METHODS</b>We examined the frequency of polymorphic genotypes of the MMP-9 promoter (-1562C/T) in 100 COPD patients and 98 healthy smokers by restriction fragment length polymorphism.</p><p><b>RESULTS</b>The frequencies of polymorphic genotypes in promoters of MMP-9 were C/C 86%, C/T 14% in COPD group; and C/C 98%, C/T 2% in the control group. There were significant differences between the two groups (P < 0.01). The allele frequencies were also significantly different between the COPD group and the control group (C allele frequency: 93% vs 99%, T allele frequency: 7% vs 1%, P < 0.05 respectively).</p><p><b>CONCLUSION</b>The genetic polymorphism in promoters of MMP-9 gene is associated with the susceptibility to COPD in the Han population of South China.</p>

Intensity modulated radiation therapy for 49 patients with recurrent nasopharyngeal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility, toxicity and tumor control of intensity modulated radiation therapy (IMRT) for recurrent nasopharyngeal carcinoma.</p><p><b>METHODS</b>Fourty-nine patients (Karnofsky performance status (KPS) >or= 80) with local-regional recurrence in the nasopharynx were treated with full course IMRT. Three patients with cervical lymph node metastasis (N1 2 and N3 1) were further supplemented with 5 to 6 courses of chemotherapy (Cisplatin + 5-Fu) after IMRT.</p><p><b>RESULTS</b>The results of treatment plan showed that the mean dose of covering gross tumor volume (GTV) (D(95)) in the nasopharynx was 68.09 Gy and the mean volume of GTV (V(95)) receiving the 95% dose was 98.46%. The mean dose of GTV, clinical target volume CTV1 and CTV2 in the targets were 71.40 Gy, 63.63 Gy and 59.81 Gy. The median follow-up time was 9 months (range 3 to 16 months). The local-regional progression-free survival was 100% with local-regional residual disease in 3 (6.1%) cases but was complicated with nasopharyngeal mucosa necrosis in 14 (28.6%) cases after IMRT.</p><p><b>CONCLUSION</b>Intensity modulated radiation therapy, as a re-treatment option for recurrent nasopharyngeal carcinoma, is able to improve the tumor target coverage and spare the adjacent critical structures. As high dose IMRT can result in radio-necrosis of nasopharyngeal mucosa, the prescription dose of GTV should be suitably decreased to 60 - 65 Gy.</p>

Changes of ACE and ERK in rabbits with hyperthyroid cardiomyopathy induced by Levothyroxine / 第三军医大学学报

Objective To explore the etiology of hyperthyroid cardiomyopathy. Methods Forty New Zealand rabbits were randomly and equally divided into 4 groups: control group, levothyroxine(L-Thy) group, imidapril group, and valsartan group. Except the control group, rabbit model of hyperthyroidism was established by daily intraperitoneal injections of L-Thy (45 ?g?kg-1?d-1? 28 d), and the animals of later 2 groups received 0.5 mg/kg imidapril and 8 mg/kg valsartan respectively at same period. Ventricular tissues were collected at 4 weeks. Cardic hypertrophy index, cardiomyocyte diameter, structural and ultrastructural changes were detected. Cardiac fibrosis was displayed by Masson’s staining and collagen volume fraction (CVF) was measured using pathological image analytic system. Expressions of angiotensin converting enzyme (ACE), extracellular signal-regulated kinase (ERK), and phosphorylated ERK (p-ERK) were evaluated with Western blot analyses. Results Compared with control group, rabbits of L-Thy group displayed remarkable myocardial hypertrophy, extracellular matrix fibrosis, and morphological changes in both structure and ultrastructure. Western blot analysis revealed increased protein expressions of ACE,ERK and p-ERK proteins. ERK and p-ERK expressions were correlated positively well with both cardiomyocyte diameter and CVF. Both imidapril and valsartan alleviated cardiomyocyte hypertrophy, extracellular matrix fibrosis, and structural damage induced by L-Thy. Compared with L-Thy group, expressions of lower ERK and p-ERK were found in both imidapril and valsartan groups. Conclusion Renin-angiotension system (RAS) and ERK signaling pathway may play important roles in hyperthyroid cardiomyopathy. Activated RAS is possibly responsible for activation of ERK signaling pathway. Imidapril and valsartan may inhibit activation of ERK signaling pathway and retarding myocardial remodeling in hyperthyroid cardiomyopathy induced by L-Thy.

Prognostic analysis of intensity modulated radiotherapy for locally recurrent nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective To report the clinical outcome and prognostic factors for locally recurrent nasopharyngeal carcinoma(NPC)treated with intensity modulated radiotherapy(IMRT).Methods From January 2001 to August 2004,the data of 132 such NPC patients were analyzed retrospectively;104 male and 28 female with a median of 44.5 years(range 21-73 years).Ninety-eight patients(74.2%)were confirmed by biopsy as having NPC:9 with WHO TypeⅡand 89 WHO TypeⅢ.The other 34 patients were only diagnosed by MRI scan because of the extension/invasion was in the base of skull and/or cavernous sinus.Median interval time were 24 months(range 6-184 months).According to the 1992 Chinese Fuzhou Staging System:stageⅠ3.8 %,Ⅱ10.6 %,Ⅲ22.0% andⅣa 63.6%;T1 5.3%,T2 10.6%,T3 22.7% and T4 55.3%.Twenty-two patients had recurrence in the neck lymph nodes.IMRT was given with the sequential tomotherapy system(NOMOS Peacock systems)of 6 MV X-rays.Prescription dose was 60-70 Gy in GTV,with the fractional dose of 1.94-2.8 Gy.Sixty patients were also supplemented with two to six courses of cisplatin-based chemotherapy.Results The median volume of GTV was 39.5 cm~3(range 0.8-158.9 cm~3).The D95,V95,mean dose and fractionation dose of GTV was 66.9 Gy,98.3%,69.8 Gy and 2.32 Gy,respectively.The median follow-up time was 12 months(range,2-47 months).The 1-,2-and 3-year local progression-free rate was 96.4%,88.4% and 85.3%,respectively.The overall 1-,2-and 3-year survival rate was 6.5.9%,49.6% and 41.6%,respectively.Eleven patients developed distant metastases.Forty-seven patients were observed to devdop mucosa necrosis and/or massive hemorrhage in the nasopharynx.On univariate and multivariate analysis,fractional dose and vohane of GTV were significant prognostic factors for overall survival(P=0.016,0.009).Conclusions The local control and survival rate can be improved for patients with locally recurrent nasopharygeal carcinoma after treatment of intensity modulated radiotherapy.The fractional dose and volume of GTV are independent prognostic factors for the overall survival. The main death reasons are mucosa necrosis and/or massive hemorrhage in the nasopharynx.

A new metallic oxide semiconductor field effect transistor detector for use of in vivo dosimetry / 中华放射肿瘤学杂志

To investigate the application of a recently developed metallic oxide semiconductor field effect transistor(MOSFET)detector for use in vivo desimetry.Methods The MOSFET detector was calibrated for X-ray beams of 8 MV and 15 MV,as well as electron beams with energy of 6,8,12 and 18 MeV.The dose linearity of the MOSFET detector was investigated for the doses ranging from 0 up to 50 Gy using 8 MV X-ray beams.Angular effect was evaluated as well in a cylindrical PMMA phantom by changing the beam entrance angle every 15?clockwise.The MOSFET detector was then used for a breast cancer patient in vivo dose measurement, after the treatment plan was verified in a water phantom using a NE-2571 ion chamber,in vivo measurements were performed in the first and last treatment,and once per week during the whole treatment.The measured doses were then compared with planning dose to evaluate the accuracy of each treatment.Results The MOSFET detector represented a good energy response for X-ray beams of 8 MV and 15 MV,and for electron beams with energy of 6 MeV up to 18 MeV.With the 6 V bias,Dose linearity error of the MOSFET detector was within 3.0% up to approximately 50 Gy,which can be significantly reduced to 1% when the detector was calibrated before and after each measdurement.The MOSFET response varied within 1.5% for angles firm 270?to 90?.However,maximum error of 10.0% was recorded comparing MOSFET response between forward and backward direction.In vivo mea surement for a breast cancer patient using 3DCRT showed that,the average dose.deviation between measurement and calculation was 2.8%,and the maximum error was less then 5.0%.Conclusions The new MOSFET detector,with its advantages of being in size,easy use,good energy response and dose linearity,can be used for in vivo dose measurement.