Verification Phantom-based clinical quality control and detection of the MLC of CyberKnife M6 / 中华放射医学与防护杂志

Objective:To provide a new morning check method for the output dose stability of the multileaf collimator (MLC) of the CyberKnife M6 (CK-M6) system.Methods:The CT images of a verification phantom with a size of 20 cm × 20 cm × 10 cm were transmitted into the Precision Treatment Plan ning System (ver. 1.1.1.1). The high-precision alignment between the accelerator output front and the fixed position of the phantom surface was achieved using the fiducial tracking method. A 10 cm × 10 cm radiation field was formed by the MLC and a DailyCheck plan with an output of 200 MU was designed. The repeatability, sensitivity, and accuracy of the DailyCheck plan were measured, and the CK-M6 system was continuously tested for one month using the artificial fixed method and the DailyCheck plan designed in this study. Results:The average and the standard deviation of 10 repeated measurements by the DailyCheck plan were 492.28 pC and 0.09, respectively, indicating good stability. There was a linear correlation between the measured values and the output dose, with a correlation coefficient of R2 > 0.999. Moreover, there was a position deviation of 2 mm between the phantom and the accelerator output front, and the result ant effect on the measured values was equivalent to a dose deviation caused by an output of 1.24 MU. The result from the continuous measurement of both the artificial fixed method and the DailyCheck plan fell within permissible limits, showing high consistency. Conclusions:The DailyCheck plan established through the fiducial tracking of a verification phantom can achieve the convenient, quick, and accurate daily detection of the output dose stability of the MLC of CK-M6. Therefore, this method can be widely applied in the clinical quality control of the CK-M6 system.

Research progress of the effect of enteral nutrition on intestinal microecology in neurocritical ill patients / 中华危重病急救医学

The intestinal flora and the intestinal environment in which it resides together constitute the intestinal microecosystem, it is significantly disturbed in neurocritical ill patients, as manifested by the decrease of bacterial diversity, an increase of pathogen, and the destruction of the intestinal barrier. Appropriate enteral nutrition is effective in maintaining intestinal barrier stability, regulating intestinal immune function, inhibiting intestinal inflammation, and regulating specific intestinal microbiota and intestinal function. It is important for sustaining intestinal microecological balance, reducing clinical complications in patients, and is a new target for the treatment of neurocritical ill patients. This review elaborates the alteration of intestinal microecology and treatment options recommended by current clinical guidelines in neurocritical ill patients and summarizes the research progress of the effects of enteral nutrition and several nutritional additives on intestinal flora and intestinal functions, to provide a reference for the follow-up research.

Role of striatal HCN4 channels in striatum in paclitaxel-induced neuropathic pain in rats: its relationship with GABA B receptors / 中华麻醉学杂志

Objective:To evaluate the role of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels in striatum in paclitaxel-induced neuropathic pain and the relationship with GABA B receptors in rats. Methods:Healthy clean-grade male Sprague-Dawley rats, aged 6-9 weeks, weighing 180-220 g, were used in this study.The neuropathic pain model was established by intraperitoneal injection of paclitaxel 2 mg/kg once every 2 days for 7 consecutive days in anesthetized rats, and then intrathecal catheterization was performed.Fifty rats in which intrathecal catheters were successfully implanted were divided into 5 groups ( n=10 each) using a random number table method: paclitaxel group (P group), paclitaxel plus normal saline group(N group), paclitaxel plus lentivirus empty vector group (BV group), paclitaxel plus HCN4 channel lentivirus group (H group), and paclitaxel plus HCN channel inhibitor ZD7288 group (I group). Ten rats of the same age were selected as the blank control group (C group). At 15 days after intraperitoneal injection of paclitaxel, normal saline 20 μl was intrathecally injected in group N, group BV received intrathecal injection of HCN4 channel lentivirus empty vector 1×10 8 TU/ml, 20 μl, group H received intrathecal injection of HCN4 channel lentivirus 1×10 8 TU/ml, 20 μl, and group I received intrathecal injection of ZD728830 μg, 20 μl.The mechanical paw withdrawal threshold (MWT) was measured at 1 day before paclitaxel injection and 14 and 21 days after injection.The cerebral striatum tissues were obtained at T 2, and the expression of HCN4 channel and GABA B receptors was determined by immunohistochemistry and Western blot. Results:Compared with group C, the MWT was significantly decreased, HCN4 channel expression was up-regulated, and GABA B receptor expression was down-regulated in group P ( P<0.05). Compared with group P, the MWT was significantly increased, HCN4 channel expression was down-regulated, and GABA B receptor expression was up-regulated in group H and group I ( P<0.05), and no significant change was found in the parameters mentioned above in group N and group BV ( P>0.05). Conclusion:Up-regulation of expression of HCN4 channels in striatum can induce down-regulation of GABA B receptor expression, which is involved in the pathophysiological mechanism of paclitaxel-induced neuropathic pain in rats.

Chemosensitivity of miRNA-17-92 high expression in leukemia animal models and the chemosensitization function of compound Zhebei granules / 白血病·淋巴瘤

Objective@#To observe the effect of miR-17-92 overexpression on the chemosensitivity of leukemia mice and the chemosensitivity of compound Zhebei granules.@*Methods@#The miR-17-92 over-expressed cells and L1210 cells were conventionally infused into each DBA/2N mouse through the vena caudalis at the cellular concentration of 100×104. The mice were divided into 5 groups with a randomized method, including miR-17-92 high expression L1210 cell leukemia mice (miR-17-92) observation group, miRNA-17-92 chemotherapy group, miRNA-17-92 chemotherapy combined with compound Zhebei granules group, L1210 chemotherapy group and normal control group. The chemotherapy groups were given cyclophosphamide by intraperitoneal injection, or chemotherapy combined with compound Zhebei granules group plus compound Zhebei. In the course of the experiment, the routine blood and white blood cell classification were checked every 7 days. The animals were killed on the 15th day or before dying. Peripheral blood routine and white blood cell classification were detected, the proportion of leukemia cells was checked by using bone marrow morphology. Furthermore, it was necessary to weigh the spleen and observe histopathological changes. P-glycoprotein (P-gp) expression was detected by using enzyme-linked immunosorbent assay.@*Results@#The difference between hemoglobin and platelet count on the 15th day after administration was statistically significant in the miRNA-17-92 observation group, miRNA-17-92 chemotherapy group, miRNA-17-92 chemotherapy combined compound Zhebei group, L1210 chemotherapy group, and normal control group (F= 5.76, P= 0.002; F= 16.90, P= 0.002); Compared with the normal control group, peripheral blood leukocyte count in the miRNA-17-92 observation group was decreased (P < 0.05). The proportion of peripheral blood leukemic cells was (37.2±13.1)%, (5.7±1.9)%, (1.3±0.8)%, (0.8±0.3)%, 0, and the proportion of myeloid leukemia cells was (26.9±11.0)%, (6.8±2.0)%, (3.2±1.0)%, (1.7±1.2)%, 0, and the difference was statistically significant (F= 24.38, P= 0.000 0; F= 19.71, P= 0.000 0). The spleen weights were (0.70±0.18), (0.20±0.07), (0.44±0.17), (0.23±0.19), (0.60±0.18) g respectively, and the difference was statistically significant (F= 8.78, P= 0.032). Chemotherapy could reduce leukemia spleen infiltration. P-gp was (33±11), (27±11), (32±11), (20±11), (17±3) ng/ml, and the difference was statistically significant (F= 10.42, P= 0.034). Compound Zhebei granules did not significantly reduce P-gp expression.@*Conclusions@#The overexpression of miRNA-17-92 leads to the decrease of chemotherapy response rate. Compound Zhebei granules combined with chemotherapy could improve the response rate of miR-17-92 high expression L1210 mice.

The mechanism of fluoride-induced cell autophagy: a recent advance / 中华地方病学杂志

Long-term exposure to fluoride can cause chronic fluorosis,and leading to damage to various tissues of the body.Recent studies have shown that fluoride can induce cell autophagy,and preliminary progress has been made in the study.Therefore,the authors reviewed the mechanism of fluoride-induced autophagy and the relationship between autophagy and apoptosis,and provide the basis for further research.

Effects of asymmetric dimethylarginine on apoptosis and expression of c-Jun N-terminal kinase in endothelial outgrowth cells / 天津医药

Objective To investigate the effects of asymmetric dimethylarginine (ADMA) on apoptosis and phosphorylation of c-jun N-terminal kinase (JNK) in endothelial outgrowth cells (EOCs). Methods The mononuclear cells were harvested from umbilical cord blood by ficoll density gradient centrifugation, and induced into EOCs and then expanded in vitro. The identified EOCs were treated with different concentrations of ADMA (0, 1, 5, 10, 20 μmol/L) for 48 h. The adherent cells were treated with 10 μmol/L ADMA,then different concentrations of JNK specific inhibitor SP600125 (0, 5,10,20 and 40 μmol/L) were added and incubated for 48 hours. Caspase-3 activity was measured by microplate reader. Apoptotic incidences of EOCs were quantitatively determined by flow cytometry. The expression of Caspase- 3 and phosphorylase-JNK (p-JNK) were detected by Western blot assay. Results The treatment of ADMA (1-20 μmol/L) significantly induced apoptosis in EOCs by enhancing Caspase-3 express and also induced phosphorylation of JNK (P<0.05). Meantime, the JNK specific inhibitor SP600125 could attenuate the apoptosis induced by ADMA during this process (F=6.733,P<0.05) and inhibit the expression of Caspase-3 and p-JNK. Conclusion ADMA can induce apoptosis in EOC, which may be achieved by activating JNK signal transduction pathway.

Correlations of red blood cell distribution width with risk and severity of noncardiac ischemic stroke / 国际脑血管病杂志

Objective To investigate the correlation between the red blood cell distribution width (RDW) with risk and and severity of noncardiac ischemic stroke.Methods The patients with acute noncardiac ischemic stroke were enrolled retrospetively and were used as a case group,and the non-stroke patients admitted to the Department of Neurology at the same period were served as a control group.The National Institutes of Health Stroke Scale (NIHSS) was used to assess the baseline neurological deficits.The NIHSS score ＜ 8 was defined as mild stroke and ≥ 8 was defined as moderate to severe stroke.The demographics,clinical data,and RDW were collected and compared.Multivariate logistic regression analysis was used to identify the independent risk factors for the risk of disease and severity of stroke in noncardiac ischemic stroke.Receiver operator characteristic (ROC) curve was used to analyze the predictive value of RDW for acute noncardiac ischemic stroke and its severity.Results A total of 1 173 patients with acute noncardiac ischemic stroke were enrolled.Over the same period,996 non-stroke patients were hospitalized in the Department of Neurology.The RDW in the case group was significantly higher than that in the control group (13.1％ ± 1.0％ vs.12.7％ ±0.7％;t=9.545,t ＜0.001).Multivariatelogistic regression analysis showed that RDW (odds ratio [OR] 9.920,95％ confidence interval [CI] 6.286-15.655,P＜ 0.001) was an independent risk factor for acute noncardiac ischemic stroke.ROC curve analysis showed that the RDW cutoff value for predicting acute noncardiac ischemic stroke was 12.55％,the area under the ROC curve was 0.611 (95％ CI 0.588-0.635),the sensitivity was 73.3％,the specificity was 43.7％,the positive predictive value was 60.5％,the negative predictive value was 58.2％,and the accuracy was 59.7％.RDW in the moderate to severe stroke subgroup was significantly higher than that in the mild stroke subgroup (13.7％ ± 1.6％ vs.12.9％ ± 0.6％,t =-13.794,P＜ 0.001).Multivariate logistic regression analysis showed that RDW (OR 3.835,95％ CI 3.002-4.899,P ＜ 0.001) was an independent risk factor for the severity of acute non-cardiac ischemic stroke.ROC curve analysis showed that the RDW cutoff value for predicting moderate to severe non-cardiac ischemic stroke was 13.45％,the area under the ROC curve was 0.713 (95％ CI 0.674-0.752),the sensitivity was 47.7％,the specificity was 86.1％,the positive predictive value was 49.8％,the negative predictive value was 85.1％,and the accuracy was 77.6％.Conclusions RDW is an independent risk factor for acute non-cardiac ischemic stroke.Increased RDW is associated with the severity of acute non-cardiac ischemic stroke.

Comparative study about three depression scales for screening depression in patients with epilepsy / 临床神经病学杂志

Objective To assess and compare the Beck Depression Inventory-II ( BDI-Ⅱ) , Hospital Anxiety and Depression Scale-Depression Subscale ( HADS-D) and Center for Epidemiologic Studies Depression Scale ( CES-D) as screening instruments for depression in patients with epilepsy .Methods One hundred and seventeen patients diagnosed with epilepsy were evaluated by BDI-Ⅱ, HADS-D and CES-D, the performance of BDI-Ⅱ, HADS-D and CES-D was evaluated by ROC curve .Results There were 33 epileptics with depression .The sensitivity and specificity of BDI-Ⅱfor the diagnosis of depression was around 90% for critical value 16, the sensitivity of CES-D was more than 80%for critical value 15, and specificity was 72.6%.The sensitivity and specificity of HADS-D was more than 80%for critical value 9, and the sensitivity of HADS-D was 91.3% for critical value 7, and specificity was 76.8%.Three instruments showed a negative predictive value of over 90%.Comparisons of the areas under the ROC curve for these instrument were not statistically significant difference (all P>0.05).Conclusion HADS-D is a brief efficient screening instruments to identify depression in patients with epilepsy .

Effects of Intra-Abdominal Implantation of Sustained-Releasing Fluorouracil on Expressions of Survivin, Caspase-3 and CD44V6 in Patients with Colorectal Cancer / 天津医药

Objectives To observe the pre and post-operational changes of the expressions of survivin, caspase-3 and CD44V6 in patients with colorectal cancer after intra-abdominal implantation of sustained releasing fluorouracil. Meth-ods Sixty-four patients with colorectal cancer (Dukes’stage of B and C) were divided into treatment group and control group, 32 patients in each group. The standard radical surgery was performed in two groups of patients. The fluorouracil im-plants were implanted intra-abdominally in treatment group. The peripheral blood levels of surviving and caspase-3 were de-tected by RT-PCR. The level of CD44V6 was detected by flow cytometry in two groups of patients. Results There were no significant differences in levels of survivin, caspase-3 and CD44V6 before surgery between two groups (P>0.05). The level of survivin (0.362 ± 0.183) was significantly lower at 14 days after operation in treatment group than that of control group (0.585±0.207), but the level of caspase-3 (2.001±0.146) was significantly higher than that of control group (1.654±0.111). The levels of CD44V6 were significantly lower in treatment group (1.857±0.535) and control group (3.471±0.496) after opera-tion than those before operation (9.557±1.170 and 9.729±0.943, P＜0.05), and the level of CD44V6 was significantly lower in treatment group than that of control group (P＜0.05). Conclusion The implant for the sustained release of fluorouracil showed a positive impact on micrometastases and prognosis of colorectal cancer, while improved the long-term efficacy of postoperative colorectal cancer.

Relationship between Acute Cerebral Infarction and Seasonal Variations in Tianjin / 天津医药

Objective To explore the influence of seasonal variations on acute cerebral infarction outcome. Meth-ods We collected data from acute cerebral infarction patients in the Second Hospital of Tianjin Medical University from January 2009 to February 2012. All cases were classified by months and seasons into different groups to analyze the season-al variations retrospectively. Results (1) The percentage of good outcome of acute cerebral infarction show significant dif-ference between each month(P<0.01). The percentage of good outcome was highest in August(92.1%), lowest in Decem-ber(78.1%), second lowest in April(81.9%). The percentage of good outcome in summer(91.6%)was higher than spring (87.2%), autumn(86.4%)and winter(83.9%)(P<0.05). (2) Among those patients converted to bad outcome more pa-tients was attacked by cerebrovascular accident in winter(68.3%)than in summer(43.2%), and more patients was combined with a pulmonary infection in winter(69.5%)than in summer(48.6%)and in autumn(49.3%)(P<0.05). (3) Seasonal effect in acute cerebral infarction outcome was obvious in those≥65 years of age(P<0.05). Conclusion Seasonal changes are associated with the outcome and severity of acute cerebral infarction.

Effects of acupuncture at acupoints at different time points on occurrence of postoperative nausea and vomiting in patients undergoing radical rectal cancer operation: determination of plasma gastrin concentration / 中华麻醉学杂志

Objective To investigate the effects of acupuncture at acupoints at different time points on the occurrence of postoperative nausea and vomiting ( PONV ) in patients undergoing radical rectal cancer operation.Methods One hundred and thirty ASA Ⅰ - Ⅲ patients,aged 40-59 yr,with body mass index of 20-25 kg/m2,scheduled for elective radical rectal cancer operation,were randomly divided into 5 groups ( n =25 each):control group ( group Ⅰ ),treatment with the conventional drug group (group Ⅱ ),preoperative acupuncture group ( group Ⅲ ),acupuncture during operation group (group Ⅳ ),and postoperative acupuncture group (group Ⅴ ).Granisetron 3 mg was injected intravenously before the end of the operation in group Ⅱ.Acupuncture was performed at 30 min before induction of anesthesia,at skin incision and at the end of operation in groups Ⅲ,Ⅳ and Ⅴ respectively.Bilateral Neiguan ( PC6 ),Hegu ( LI4 ),Zhigou ( SJ6 ),and Quchi ( LI11 ) acupoints were selected in groups Ⅲ,Ⅳ and Ⅴ.Acupuncture stimulation lasted for 30 min.Blood samples were collected from the peripheral vein after admission to the operating room (T0),at 1 h after skin incision (T1),at the end of operation (T2 ),and at 24 h after operation (T3) to determine the plasma gastrin concentration.The occurrence of PONV was recorded within 2 h after operation,during 2-6 h,6-12 h and 12-24 h after operation,and within 24 h after operation.Results Compared with group Ⅰ,the incidence of PONV within 2 and 24 h after operation,and the plasma gastrin concentration at T3 were significantly decreased in groups Ⅱ and Ⅲ ( P ＜ 0.05),and no significant change was found in the indexes mentioned above in groups Ⅳ and Ⅴ (P ＞ 0.05).Compared with group Ⅱ,the plasma gastrin concentration at T3 was significantly decreased in group Ⅲ,the incidence of PONV within 2 and 24 h after operation was significantly increased in groups Ⅳ and Ⅴ ( P ＜ 0.05).Compared with group Ⅲ,the incidence of PONV within 2 and 24 h after operation,and the plasma gastrin concentration at T3 were significantly increased in groups Ⅳ and Ⅴ ( P ＜ 0.05 ).Conclusion Preoperatvie acupuncture at acupoints can decrease the occurrence of PONV in patients undergoing radical rectal cancer operation,the efficacy is similar to that of the conventional drugs,and the decreased concentration of the plasma gastrin after operation is involved in the mechanism.

Effect of implanted sustain-released 5-fluorouracil during operation in patients with advanced rectal cancer / 中国综合临床

Objective To assess the effect of intraperitoneal interstitial implant of Sustained-release 5-Fluorouracil during operation for advanced rectal cancer. Methods One hundred and four cases with advanced rectal cancer were enrolled into the study and divided into 3 groups: treatment group 1(n = 37), underwent combined hypotonic peritoneal chemo-hyperthermia and Sustain-released 5-fluorouracil implantation treatment during operation; treatment group 2(n = 34), underwent combined intraoperative hypotonic peritoneal chemohyperthermia and early postoperatively intraperitoneal chemotherapy treatment; and control group(n = 33),underwent peritoneal lavage during radical resection alone. Results Digestive tract toxicity in group 1 was significantly lower than that in group 2(2. 70% vs. 20. 59%, x2 = 9. 104, P ＜ 0. 05). There were significant difference on 1 year survival rate among the three groups. The 2-year survival rate of group 1 was significantly higher than that in the control group (78. 37% vs. 48. 48%, x2 = 1. 297 ,P ＜ 0. 05). After two years follow-up the 2-year local recurrence rate of group 1 was significantly lower than that in the control group(21.62% vs 32. 35 %, x2 = 7. 001, P ＜ 0. 05). However, no significant difference was found compared to group 2, which was 32. 35%. Conclusion lntraperitoneal interstitial implant of Sustain-released 5-Fluorouracil during operation is an effective intraperitoneal chemotherapy with mild side effects for advanced rectal cancer.

The effects of ketamine on learning and memory function in the pregnant rat' s offspring / 中华行为医学与脑科学杂志

Objective To investigate whether pregnant rats exposure to ketamine cause offspring changes in space cognitive abilities and exploration abilities.Methods 3-month Sprague-Dawley female rats ( n =24)were randomly divided into four groups:group N (control group),group K1 (small doses of ketamine group),group K2 ( clinical anesthesia dose of ketamine group),group K3 ( large doses of ketamine group).3-month Sprague-Dawley male rats ( n =4) and female rats were mated at the same cage by the proportion of 2∶ 1.Pregnant mice were treated at tenth day:group N were treated saline with equal-volume to ketamine vein injection; group K1,group K2,group K3 administered vein injection 3,8,20mg/kg of ketamine.Then the 20-day offspring rats'learning and memory were assessed used Open Field Test ( record the time of the offspring in the central case through the number of grid within 2 min ) and Hole Board Test ( Counting the times of offspring stretch into the hole in 5 min) at postnatal days 20.Results In the Open Field Test,the retention time in central check of group N,group K2 and group K3 were (2.45 ± 1.23)s,(6.42 ±2.50)s,(6.41 ±2.19)s.Compared with group N,the retention time in central check of group K2 and group K3 were significantly higher (F=13.42,P＜0.01 ),and group K1 were not significant different ( t =1.33,P＞0.01 ),and the locomotion of group K1,group K2,group K3 were significantly reduced( ( 15.33 ± 6.81 ),( 13.75 ± 5.93 ),( 16.92 ± 6.54 ),F =4.24,P ＜ 0.05 ).In the Hole Board Test,the times of offspring stretch into the hole were not significant different comparing with the control group(F=2.17,P ＞ 0.05 ).Conclusion The dose of ketamine that equivalented clinical anesthesia can affect offspring rats' space cognitive abilities; but the exploring cognitive ability were not significantly influenced.

Expression of IL-21 in the peripheral blood of myasthenia gravis patients and its correlation with anti-AChR-Ab class switch / 中南大学学报(医学版)

OBJECTIVE@#To explore the role of IL-21 in the pathogenesis of myasthenia gravis (MG) and its influence on the the class switch of anti-AChR antibodies.@*METHODS@#Blood was taken from 26 patients and 18 healthy controls, and the expression of IL-21R mRNA in peripheral blood mononuclear cells (PBMCs) was detected by RT-PCR. The expression of IL-21R on B lymphocytes was measured by flow cytometry, while the concentrations of serum IL-21 and the levels of anti-AChR-IgG and its isotype IgG(1), IgG(2), and IgG(3) were tested by ELISA.@*RESULTS@#The serum concentration of IL-21 in the MG group was higher than that in the control group (31.686±8.499 pg/mL, 15.147±6.366 pg/mL) and the difference was significant (P0.05). Compared with the control group, the expression of IL-21R on B lymphocytes also increased in the MG group (P0.05). Expression of IL-21R mRNA in the PBMCs showed no correlation with the level of serum anti-AChR-IgG and its isotype IgG(1), IgG(2), and IgG(3), respectively(P>0.05); however the expression of IL-21R in B lymphocytes showed positive correlation with anti-AChR-IgG and it's isotype IgG(1) and IgG(3) (P0.05).@*CONCLUSION@#IL-21 might induce the class switch of anti-AChR antibodies to IgG(1) and IgG(3) isotype through IL-21R on B lymphocytes which promotes the pathogenesis of the MG.

Comparison of two different prosthetic materials in the treatment of inguinal hernia in aged patients / 中国组织工程研究

0.05). There were 7 cased in the polypropylene mesh group had abdominal discomfort due to stiffness, which higher than that of the expanded polytetrafluroethylene patch and control groups (P 0.05). CONCLUSION: Both prosthetic patches are safe and effective when used in the repair of inguinal hernia in aged patients with low recurrence rate, especially, the expanded polytetrafluroethylene patch, which is more comfortable than polypropylene mesh.