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BACKGROUND@#After major liver resection, the volume status of patients is still undetermined. However, few concerns have been raised about postoperative fluid management. We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection (LLR) with or without inferior vena cava (IVC) respiratory variability-directed fluid therapy in the anesthesia intensive care unit (AICU).@*METHODS@#This randomized controlled clinical trial enrolled 70 patients undergoing LLR. The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU, while the standard practice of fluid management was used for the control group. The primary outcome was the time to flatus after surgery. The secondary outcomes included other indicators of gut function recovery after surgery, postoperative length of hospital stay (LOS), liver and kidney function, the severity of oxidative stress, and the incidence of severe complications associated with hepatectomy.@*RESULTS@#Compared with patients receiving standard fluid management, patients in the intervention group had a shorter time to anal exhaust after surgery (1.5 ± 0.6 days vs. 2.0 ± 0.8 days) and lower C-reactive protein activity (21.4 [95% confidence interval (CI): 11.9-36.7] mg/L vs. 44.8 [95%CI: 26.9-63.1] mg/L) 24 h after surgery. There were no significant differences in the time to defecation, serum concentrations of D -lactic acid, malondialdehyde, renal function, and frequency of severe postoperative complications as well as the LOS between the groups.@*CONCLUSION@#Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR.@*TRIAL REGISTRATION@#ChiCTR-INR-17013093.
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Humanos , Hepatectomía , Vena Cava Inferior/cirugía , Hígado , Laparoscopía , FluidoterapiaRESUMEN
Pulmonary hypertension (PH) is an insidious pulmonary vasculopathy with high mortality and morbidity and its underlying pathogenesis is still poorly delineated. The hyperproliferation and apoptosis resistance of pulmonary artery smooth muscle cells (PASMCs) contributes to pulmonary vascular remodeling in pulmonary hypertension, which is closely linked to the downregulation of fork-head box transcriptional factor O1 (FoxO1) and apoptotic protein caspase 3 (Cas-3). Here, PA-targeted co-delivery of a FoxO1 stimulus (paclitaxel, PTX) and Cas-3 was exploited to alleviate monocrotaline-induced pulmonary hypertension. The co-delivery system is prepared by loading the active protein on paclitaxel-crystal nanoparticles, followed by a glucuronic acid coating to target the glucose transporter-1 on the PASMCs. The co-loaded system (170 nm) circulates in the blood over time, accumulates in the lung, effectively targets the PAs, and profoundly regresses the remodeling of pulmonary arteries and improves hemodynamics, leading to a decrease in pulmonary arterial pressure and Fulton's index. Our mechanistic studies suggest that the targeted co-delivery system alleviates experimental pulmonary hypertension primarily via the regression of PASMC proliferation by inhibiting cell cycle progression and promoting apoptosis. Taken together, this targeted co-delivery approach offers a promising avenue to target PAs and cure the intractable vasculopathy in pulmonary hypertension.
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Objective:To determine the change in the expression of tumor necrosis factor receptor-associated factor 6 (TRAF6) in lung tissues of rats with pulmonary hypertension (PH).Methods:Sixteen SPF-grade healthy male Sprague-Dawley rats, aged 8 weeks, weighing 200-220 g, were divided into 2 groups ( n=8 each) by the random number table method: control group (group C1) and PH group (group PH1). The model of PH was prepared by subcutaneous injection of monocrotaline. On day 28 after developing the model, the mean pulmonary arterial pressure (mPAP) was measured, and the Fulton index was calculated, and the percentage of media wall thickness of the small and medium pulmonary arteries and percentage of muscularized vessels were also calculated. The expression of TRAF6, transcription-3 (STAT3), phosphorylated STAT3 (p-STAT3) and Cyclin D1 in lung tissues was detected by Western blot, and p-STAT3/STAT3 ratio was calculated. The interaction between TRAF6 and STAT3 was determined by immunoprecipitation assay. Primarily cultured pulmonary artery smooth muscle cells of normal rats (group C2) and pulmonary artery smooth muscle cells of rats with PH (group PH2) were inoculated in 6-well plates ( n=3 each). The expression of TRAF6 mRNA was detected by quantitative polymerase chain reaction. The expression of TRAF6, STAT3, p-STAT3 and Cyclin D1 was detected by Western blot. Results:Compared with group C1, the mPAP, Fulton index, percentage of media wall thickness of the small and medium pulmonary arteries and percentage of muscularized vessels were significantly increased, the expression of TRAF6 and Cyclin D1 in lung tissues was up-regulated, the p-STAT3/STAT3 ratio was increased ( P<0.05 or 0.01), and the results of immunoprecipitation showed that TRAF6 interacted with STAT3 in group PH1. Compared with group C2, the expression of TRAF6 protein and mRNA and Cyclin D1 was significantly up-regulated, and the p-STAT3/STAT3 ratio was increased in group PH2 ( P<0.05 or 0.01). Conclusions:The expression of TRAF6 in the lung tissue is up-regulated in rats with PH, which may be related to pulmonary vascular remodeling by promoting the activation of STAT3.
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Objective:To investigate the characteristics of resting energy expenditure (REE) in children with cerebral palsy (CP) graded with different levels of Gross Motor Function Classification System (GMFCS), and to evaluate the accuracy and association of commonly used REE prediction formulas in children with CP.Methods:It was a retrospective study involving 36 children with CP aged 24-144 months who visited the Third Affiliated Hospital of Zhengzhou University between September 2021 and August 2022.REE was measured by the indirect calorimetry.Based on the GMFCS, children with CP were divided into grade Ⅰ-Ⅱ group (20 cases), grade Ⅲ group (6 cases) and grade Ⅳ-Ⅴ group(10 cases). During the same period, 11 age-matched healthy children were included in control group.The measured REE (MREE) between children with CP and healthy controls was compared.Predicted REE (PREE) calculated by the Harris-Benedict, WHO, Schofield-W, Schofield-WH and Oxford prediction formulas were compared with MREE in children for their consistency and correlation.Independent samples were analyzed using t-test or Mann- Whitney U test, and categorical data were analyzed using Chi- square test.Using paired t-test and Pearson linear correlation analysis to analyze the correlation between MREE and PREE.The accuracy of PREE values calculated by different formulas was assessed using the root mean square error. Results:The MREE in control group and children with CP were (952.18±270.56) kcal/d and (801.81±201.89) kcal/d, respectively.There was no significant difference in the MREE between grade Ⅰ-Ⅱ group versus control group[(868.30±194.81) kcal/d vs.(952.18±270.56) kcal/d, P>0.05], and grade Ⅲ group versus control group [(813.17±192.48) kcal/d vs.(952.18±270.56) kcal/d, P>0.05]. The MREE was significantly lower in grade Ⅳ-Ⅴ group than that of control group [666.00(513.50, 775.50) kcal/d vs.(952.18±270.56) kcal/d, P=0.011]. There were no significant difference between MREE and PREEs calculated by Harris-Benedict, WHO, Schofield-W, Schofield-WH, and Oxford (all P>0.05). The correct classification fraction calculated by the 5 formulas were 33.3%, 47.2%, 41.7%, 47.2%, and 41.7%, respectively.The r values of the consistency of PREE calculated by the 5 formulas were 0.585, 0.700, 0.703, 0.712, and 0.701, respectively.The Blande-Altman Limits of Agreement were (-297.77, 359.22), (-245.60, 326.94), (-250.62, 316.05), (-242.22, 177.36) and (-241.28, 325.81), respectively.The clinically acceptable range was -80.18 to 80.18 kcal/d.The root mean square error were 168.09 kcal/d, 149.64 kcal/d, 146.24 kcal/d, 144.23 kcal/d and 148.77 kcal/d, respectively. Conclusions:The MREE values decreased significantly in children with CP classified as CMFCS grade Ⅳ and Ⅴ.When REE cannot be regularly monitored by indirect calorimetry to develop nutritional support programs, children with CP may be prioritized to estimate REE using the prediction formula of Schofield-WH.
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Objective:To document the clinical features of children with cerebral palsy (CP) using magnetic resonance imaging (MRI).Methods:The gross motor functioning of 325 children diagnosed as having CP was graded using the gross motor function classification system (GMFCS). The GMFCS grades were correlated with MRI results in univariate and multivariate logistic regression analyses. The significance of any relationship between the MRI results and co-morbidities was tested using chi-squared tests.Results:Cerebral dysplasia, cerebroventricular enlargement, periventricular leukomalacia (PVL), abnormal signals in the thalami, and morphological changes after hypoxic ischemic encephalopathy were all found to be significantly correlated with GMFCS grading. Moreover, the chi-squared tests indicated that PVL children, children with thinning of the corpus callosum and/or abnormal signals in the thalami were significantly more likely to have visual, auditory or speech impairment complications and/or mental retardation.Conclusions:The findings from MRI correlate well with types of CP, GMFCS grades and co-morbidities among CP children. MRI can be an effective tool for early diagnosis and prognosis of CP in children, indicating needs for clinical rehabilitation.
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Objective:To observe any therapeutic effect of repeated transcranial direct current stimulation (tDCS) on rats modeling neuropathic pain and explore possible mechanisms.Methods:Forty adult male Sprague-Dawley rats were randomly divided into a normal group ( n=10), a sham operation group ( n=10), a treatment group ( n=10) and a sham treatment group ( n=10). A model of chronic constriction injury of the sciatic nerve was established in the latter two groups. Fourteen days after the modeling, the treatment group was given tDCS for 8 consecutive days, while the sham treatment group received sham stimulation, and the other 2 groups did not receive any intervention. Von Frey and hotplate tests were used to test the rats′ pain thresholds 1 day before, as well as 14 and 22 days after the surgery (i.e., 8 days after the end of the treatment). Spinal cord tissue samples were taken to detect the protein expressions of N-methyl-D-aspartic acid receptor 2B, gamma-aminobutyric acid receptor types A (GABA a-R) and B (GABA b-R) using western blotting. Results:On the 14th day after the operation the average 50% MWT and WTL values of the sham treatment and treatment groups had decreased significantly compared with the sham operation group. By the 22nd day the average 50% MWT and WTL values of the treatment group were significantly higher than those of the sham treatment group, but there was no significant change in the treatment group′s average WTL between the 21st and 22nd days. On the 22nd day after the operation the average NR2B-NMDA-R level of the sham treatment group were significantly higher than that of the sham operation group, while the average GABA a-R and GABA b-R levels were significantly lower. At the same time point the treatment group′s average NR2B-NMDA-R level had decreased significantly compared to the sham treatment group, while the average GABA a-R level had increased significantly. There was no significant difference in average GABA b-R level between the treatment group and the sham treatment group at that point. On the 22nd day there was also no significant difference in the average NR2B-NMDA-R level between the treatment group and the sham operation group. Conclusions:Repeated tDCS can effectively relieve neuropathic pain. The relief of hyperalgesia is more significant than that of mechanical allodynia. A possible mechanism may be the down-regulation of spinal NR2B-NMDA-R to normal levels and modest up-regulation of GABA a-R.
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Objective:To evaluate the effect of paclitaxel on the mast cell-CCL2-macrophage axis in rats with pulmonary hypertension.Methods:Thirty SPF-grade healthy male Sprague-Dawley rats, aged 8-10 weeks, weighing 180-220 g, were divided into 3 groups ( n=10 each) using a random number table method: control group (group C), pulmonary hypertension group (group PH), and paclitaxel group (group PTX). The model of pulmonary hypertension was established by subcutaneous injection of monocrotaline 60 mg/kg in rats.At 25 days after establishing the models, paclitaxel 2 mg/kg was injected via the tail vein once every four days, for 4 times in total in group PTX.The equal volume of normal saline was injected in the remaining 2 groups.The mean pulmonary artery pressure (mPAP) was performed at 40 days after establishing the model.The heart was removed and dried, the right ventricle (RV) and left ventricle plus ventricular septum (LV+ S) was weighed, and the Fulton index [RV/(LV+ S)] was calculated.The inferior lobe of left lung was taken, the ratio of media wall thickness of pulmonary vessels was calculated by HE staining, the number of Tryptase + , CD68 + , CD163 + , and Ki67 + cells was recorded by immunohistochemistry, the mean value was calculated, the percentage of Ki67-positive cells in blood vessels was recorded, and the proportion of muscularized blood vessels was calculated.The content of CCL2 was measured by enzyme-linked immunosorbent assay, and the expression of cleaved caspase-3 and Cyclin D1 was detected by Western blot. Results:Compared with group C, the mPAP, Fulton index, ratio of media wall thickness, proportion of muscularized blood vessels, the number of Tryptase + , CD68 + and CD163 + cells and percentage of Ki67 + cells were significantly increased, and the expression of cleaved caspase-3 was down-regulated in PH and PTX groups ( P<0.05), the expression of Cyclin D1 was significantly up-regulated in group PH ( P<0.05), and no significant change was found in group PTX ( P>0.05). Compared with group PH, the mPAP, Fulton index, ratio of media wall thickness, percentage of muscularized blood vessels, the number of Tryptase + , CD68 + and CD163 + cells and percentage of Ki67 + cells were significantly decreased, the expression of CCL2 and Cyclin D1 was down-regulated, and the expression of cleaved caspase-3 was up-regulated in group PTX ( P<0.05). Conclusion:The mechanism by which paclitaxel alleviates pulmonary hypertension is related to inhibiting the mast cell-CCL2-macrophage axis in rats.
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Objective:To investigate and analyze the anxiety problems in hospitalized COVID-19 patients so as to provide evidence for formulation of relevant mental health management strategies.Methods:A Psychological Questionnaire for Hospitalized COVID-19 Patients in Wuhan was used to investigate the anxiety status of the COVID-19 patients who had been hospitalized to Wuhan Tong Ji Hospital which had been assisted by Peking University People's Hospital. The patients were categorized into a mild group and a non-mild group according to The Diagnosis and Management Protocols for COVID-19 (Trial version 7). The population characteristics, anxiety status and disease recovery were analyzed in the 2 groups. Scores from 0 to 7 indicated no anxiety and ≥ 8 anxiety.Results:A total of 46 patients were included in this study, including 28 men and 18 women aged from 23 to 78 years (average, 60.9 years). There were 13 mild cases and 33 non-mild ones. There were no significant differences between the 2 groups in age or gender ( P>0.05). Of all the patients, 52.2% (24 cases) had a close relative or family member definitely diagnosed of COVID-19. To the question "Do you have any worry?" , 73.9% of the patients (34 cases) answered yes. The mild cases scored 7.3 points±2.0 points, showing mild anxiety; the non-mild cases scored 8.7 points±1.2 points, showing mild anxiety too. There were no significant differences between the mild and non-mild cases in any anxiety scoring item( P>0.05). The single factor analysis of the general data showed no significant correlation between anxiety and education, COVID-19 diagnosis of a close relative or family member, current situation of anti-COVID-19 or future life ( P>0.05), but a significant correlation between anxiety and therapeutic outcomes and the current situation of family members ( P<0.05). Conclusions:Anxiety is a common problem in hospitalized COVID-19 patients. Anxiety about prognosis and family members is the main factor affecting their psychological status. Attention should be paid to the mental health of COVID-19 patients by governments and medical staff.
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Objective To assess the incidence and related risk factors of postoperative intraabdominal infection in patients undergoing anatomical hepatectomy.Methods The clinical data from 122 patients who underwent anatomical major hepatectomy in our institution were retrospectively analyzed.The electronic medical data were retrieved for further analysis including the amount of crystalloid and colloid fluid infused,intraoperative estimated blood loss,volume of blood transfusion,the dosage of vasoactive drugs,postoperative liver function,inflammation index,the incidence of intraabdominal infection and the length of hospital stay (LOS).Results Patients were divided into infection group (n =39) and non-infection group (n =83).Intraabdominal infection was correlated with preoperative cirrhosis,the elevated direct bilirubin and alanine aminotransferase,the duration of operation,bilioenteric anastomosis or cholangiotomy,the infusion volume of colloid and crystalloid fluid,transfusion volume,direct bilirubin level on the POD 1 (post-operation on day 1) (P ＜ 0.05);Multivariate analysis showed the incidence of intraabdominal infection was highly correlated with the amount of intraoperative colloid fluid bilioenteric anastomosis(P ＜ 0.05).Conclusions Intraoperative infused volume of synthetic colloid,along with bilioenteric anastomosis are independent risk factors for postoperative intraabdominal infection.
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Objective@#To investigate the influence of unitization encoding strategy and the moderating effect of unitization level on directed forgetting effect of associative recognition.@*Methods@#Association recognition paradigm combined with directed forgetting paradigm were employed in this study.The 39 participants acquired by simple random sampling were asked to remember or forget compound words or unrelated word pairs which were randomly presented according to cues.In the retrieval stage, they needed to distinguish " old" or " rearranged" word pairs regardless of the cues.@*Results@#(1) The reversed unitization effect reached significance. The discrimination of compound words (0.43±0.03) was lower than that of unrelated words (0.55±0.03) (F=27.27, P<0.001, ηp2=0.42). For the word pairs (to be remembered, TBR), the discrimination of compound words (0.43±0.03) was lower than that of unrelated words (0.59±0.03) (t=-6.05, P<0.001); for the word pairs (to be forgotten, TBF), the discrimination of compound words (0.43±0.03) was still lower than that of unrelated words (0.50±0.04) (t=-2.30, P=0.025). (2) The directed forgetting effect of associative recognition was significant.However, TBR (0.51±0.03) was more discriminative than TBF (0.46±0.03) (F=4.30, P=0.045, ηp2=0.10). But the difference was mainly reflected in the recognition of unrelated words.TBR (0.59±0.03) was more discriminative than TBF (0.50±0.04) (t=3.19, P=0.003). However, there was no significant difference between TBR (0.43±0.03) and TBF (0.43±0.03) in recognition of compound words.@*Conclusion@#The unitization encoding stratege can simultaneously promote hit rate and false alarm rate.The directed forgetting effect can be eliminated when unitization level is high enough.
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Objective@#To assess the incidence and related risk factors of postoperative intraabdominal infection in patients undergoing anatomical hepatectomy.@*Methods@#The clinical data from 122 patients who underwent anatomical major hepatectomy in our institution were retrospectively analyzed. The electronic medical data were retrieved for further analysis including the amount of crystalloid and colloid fluid infused, intraoperative estimated blood loss, volume of blood transfusion, the dosage of vasoactive drugs, postoperative liver function, inflammation index, the incidence of intraabdominal infection and the length of hospital stay (LOS).@*Results@#Patients were divided into infection group (n=39) and non- infection group (n=83). Intraabdominal infection was correlated with preoperative cirrhosis, the elevated direct bilirubin and alanine aminotransferase, the duration of operation, bilioenteric anastomosis or cholangiotomy, the infusion volume of colloid and crystalloid fluid, transfusion volume, direct bilirubin level on the POD 1(post-operation on day 1) (P<0.05); Multivariate analysis showed the incidence of intraabdominal infection was highly correlated with the amount of intraoperative colloid fluid bilioenteric anastomosis(P<0.05).@*Conclusions@#Intraoperative infused volume of synthetic colloid, along with bilioenteric anastomosis are independent risk factors for postoperative intraabdominal infection.
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Objective To evaluate the effect of sildenafil on the expression of hexokinase-2 (HK-2) in lung tissues in a rat model of pulmonary arterial hypertension. Methods Thirty-two male Sprague-Dawley rats, aged 2 months, weighing 200-220 g, were allocated into 4 groups with 8 rats in each group using a random number table: control group ( group C), pulmonary arterial hypertension group ( group PAH), low-dose sildenafil group (group S1 ) and high-dose sildenafil group (group S2 ). The model of pul-monary arterial hypertension was established through combining left pneumonectomy with subcutaneous in-jection of 60 mg∕kg monocrotaline. Two percent sildenafil 30 and 50 mg∕kg were administered by intragastric gavage once a day for 3 consecutive weeks starting from 5 weeks after pneumonectomy in S1 and S2 groups, respectively. The chest was opened after the end of administration for measurement of mean pulmonary arte-rial pressure (mPAP) and right ventricular systolic pressure (RVSP). The hearts and lungs were excised for determination of the percentage of the thickness of tunica media of pulmonary arterioles, size of right ventricular cardiomyocytes, α-smooth muscle actin (α-SMA) expression (by immunohistochemistry) and expression of hypoxia-inducible factor-1α (HIF-1α) and HK-2 ( by Western blot). Results Compared with group C, the mPAP, RVSP and percentage of MT were significantly increased, the size of right ven-tricular cardiomyocytes was enlarged, and the expression of HIF-1α, HK-2 and α-SMA was up-regulated in PAH and S1 groups, and the RVSP and percentage of MT were significantly increased, the size of right ventricular cardiomyocytes was enlarged, and the expression of HIF-1α, HK-2 and α-SMA was up-regula-ted (P<0. 05), and no significant change was found in mPAP in group S2 (P>0. 05). Compared with group PAH, the percentage of MT was significantly decreased, the size of right ventricular cardiomyocytes was decreased, and the expression of HIF-1α, HK-2 and α-SMA was down-regulated in group S1 , and the mPAP, RVSP and percentage of MT were significantly decreased, the size of right ventricular cardiomyo-cytes was decreased, and the expression of HIF-1α, HK-2 and α-SMA was down-regulated in group S2 (P<0. 05). Conclusion The mechanism by which sildenafil inhibits proliferation of pulmonary vascular smooth muscle cells is related to inhibiting the expression of HK-2 in lung tissues in a rat model of pulmona-ry arterial hypertension.
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Objective To investigate the dosimetric effect of carbon fiber couch through virtual simulation in the XiO treatment planning system (TPS).Methods A treatment couch model of iBEAM evo Extension 650 was scanned with a big bore spiral CT and its contour was stored in the XiO TPS.The attenuation coefficient of couch was obtained by measuring the attenuated dose with and without a solid water phantom on the couch at different gantry angles (100°-180°).The optimal relative electron density (RED) values of the carbon fiber (CF) cover and foam core (FC) were adjusted according to the comparison between measured and simulated attenuation dose.The effects of the couch in the TPS on pass rate were evaluated by Octavius 4D phantom with 10 cases with lung cancer.Results The optimal RED values of CF and FC were 0.75 and 0.10 g/cm3,respectively.The measured attenuation error was the maximal at gantry angle of 120° (4.84％) without the treatment couch in the TPS.The average measured attenuation errors without the couch in the TPS dropped significantly from (2.54 ± 1.48) ％ to (-0.04 ± 0.36) ％ after inclusion of the treatment couch during dose calculation (Z =-3.621,P ＜ 0.05).The three-dimensional dose verification γ pass rate (3 mm/3％) without the couch increased significantly from (91.79± 1.25)％ to (94.74± 1.69)％ after inclusion of the couch in the dose calculation (t =6.027,P ＜ 0.05).Conclusions The effect of couch on the attenuation dose is significant.Inclusion of a virtual model of couch in XiO TPS can simulate the attenuation effect properly and improve the accuracy of dose calculation.
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Objective@#To evaluate the effects of parallel versus perpendicular double plating for distal humerus fracture of type C.@*Methods@#A standardized comprehensive literature search was performed by PubMed, Embase, Cochrane library, CMB, CNKI and Medline datebase.Randomized controlled studies on comparison between parallel versus perpendicular double plating for distal humerus fracture of type C before December 2015 were enrolled in the study.All date were analyzed by the RevMan 5.2 software.@*Results@#Six studies, including 284 patients, met the inclusion criteria.There were 155 patients in perpendicular double plating group, 129 patients in parallel double plating group.The results of Meta-analysis indicated that there were statistically significant difference between the two groups in complications (OR=2.59, 95%CI: 1.03 to 6.53, P=0.04). There was no significant difference between the two groups in surgical duration (MD=-1.84, 95% CI: -9.06 to 5.39, P=0.62), bone union time (MD=0.09, 95%CI: -0.06 to 0.24, P=0.22), Mayo Elbow Performance Score (MD=0.09, 95%CI: -0.06 to 0.24, P=0.22), Range of Motions (MD=-0.92, 95%CI: -4.65 to 2.81, P=0.63) and the rate of excellent and good results (OR=0.64, 95%CI: 0.27 to 1.52, P=0.31).@*Conclusion@#Both perpendicular and parallel double plating are effective in distal humerus fracture of type C, parallel double plating has less complications.
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Objective To study the effect of the respiratory amplitude on the dose distribution of volumetric modulated arc therapy (VMAT).Methods Respiratory motion simulation phantom (QUASAR) was used to simulate the respiratory movement from head to toe,and a two-dimensional ionization chamber matrix was used to collect the dose distribution in isocenter with different respiratory amplitude.Verisoft software and absolute dose analysis were used to analyze dose distribution,percentage errors of absolute dose in isocenter,passing rates of radiation field for the data collected,and results were compared to planned dosage.Results The effect on isocenter target dose of respiratory motion was below dose tolerance 5％ (t =-22.614--10.756,P ＜ 0.05).The respiratory movement made the dose on the edge of the target area higher,with fewer hot spots and more cold spots in the target area.As the respiratory amplitude increased,the effect of respiratory movement on the overall dose distribution in the target area was greater.The difference of the whole beam γ passing rate between 6,8,10 mm and stationary state was significant (t =3.095,8.685,14.096,P ＜ 0.05).The difference of target γ passing rate between 8,10 mm and stationary state was significant (t =6.081,9.841,P ＜0.05).Conclusions The respiratory movement could cause the dose transmission errors of VMAT,the error increased with increased range of motion.The actual radiation dose for normal tissues along the direction of respiratory movement on the target edge was higher than what was planned.
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Objective To study the effect of amplitude of respiratory movements on dose distribution of static intensity-modulated radiotherapy (IMRT),and to provide a basis for dose correction against respiratory movements.Methods A two-dimensional matrix driven by the QUASAR program-controlled respiratory movement instrument was used to simulate human respiratory movements in the head/foot direction.The dose distribution was evaluated on the isocenter plane with different amplitudes of respiratory movements.The Verisoft software and absolute dose analysis were used to analyze dose distribution,percentage errors of absolute dose,and passing rates of radiation field for both collected data and planned dose distribution.Results In spite of little effect on dose distribution in target volume,respiratory movements increased the dose outside the marginal target volume along the movement direction.When the respiratory amplitude was lower than 6 mm,the passing rate of γdistribution met the requirement of clinical dose verification;when the respiratory amplitude was larger than 8 mm,the passing rate of γ distribution was reduced with the increasing respiratory amplitude and fell below the clinical standard.Conclusions Respiratory movements have a blurring effect on static IMRT.It is possible to introduce some compensation methods to static IMRT in the treatment of tumor with periodic respiratory movements.The normal tissue at the edge of target volume along the respiratory movement direction is exposed to a higher radiation dose than expected.Therefore,the radiation dose for the normal tissue around target volume should be made as low as possible in the radiotherapy plan.For the patients with relatively large respiratory amplitude,action should be taken to lower respiratory amplitude and elevate the radiation dose in target volume.
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Objective To study the feasibility of dose verification with Octavius 4D system in volumetric modulated arc therapy (VMAT).Methods Twenty patients were treated with the VMAT.Their treatment plans were performes and then acquired the measured data with the Octavius 4D system.In addition,the treatment plans are used in the CT phantom for Octavius 4D system,and acquire the simulated data.We use the γ pass rate to analysis the measured and simulated results for the conditions:the dose deviations are 2％3％5％,the displacement deviations are 2 mm/3 mm/5 mm and the thresholds are 5％ 10％,and got the Gamma pass rate and fitness of profile curve.Results The distributions of measured and simulated dose are matched well,and the fitness of profile curve are also matched well.The averaged Gamma pass rate is 97.78％ in the case 3 mm 3％ 10％.Conclusions Octavius 4D system can meet the dose verification for VMAT treatment.The measured plane is always following the rotating frame and perpendicular to the beam.
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This study was aimed to observe the influence of qi-reinforcing and blood-activating(QRBA) herbs onan-giogenesis of the myocardial microvascular, SDF-1 and CXCR4 protein expression as well as mRNA expression in the infarcted myocardium edge area of acute myocardial infarction (AMI) ratmodel. The AMI rat model was estab-lished. The immunohistochemical staining method was used in the detection of vWF protein expression in the myocar-dial tissues. The MVC account was recorded. The SDF-1 factor and its specific receptor factor CXCR4 were detected by the western blot and realtime-PCR technique in the infarcted myocardium edge area of rats from each group. The results showed that in the new generated microvessels which were staining marked by the vWF factor can be seen in infarcted myocardium edge area of rats from the sham-operated group, model group, each medication group. The new generated microvessels in the myocardium of rats in the sham-operated group were not obvious. Small amount of new generated microvessels can be seen in rats from the model group. More new generated microvessels can be seen in rats from each medication group. The comparison between the model group and the sham-operated group showed sta-tistical difference (P<0.05). The comparison between each medication group and the model group showed statistical difference(P<0.05 or P<0.01). Compared with the sham-operated group, SDF-1, CXCR4 and mRNA expression were obviously increased in the myocardium of rats in the model group (P<0.05 or P<0.01). Compared with the model group, SDF-1, CXCR4 protein and mRNA expression were obviously increased in the myocardium of rats from each medication group (P<0.05 or P<0.01). It was concluded that herbs such as Salvia, couplet herbs of Salvia and Astra-galushad stimulation effectonangiogenesis. Mechanism of these drugs in angiogenesismay be through the promotion of SDF-1 and CXCR4 protein as well as mRNA express.
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This study was aimed to observe the influence on migration ability of human umbilical vein endothelial cell (HUVEC) in vitro by couplet medicines of reinforcing qi and activating blood, and initially screen medicines with relative obvious promoting or inhibiting effect on migration ability of HUVEC. The model of HUVEC cultured in vitro was established. The Paeonia, Ligusticum chuanxiong, Cortex moutan, Salvia, curcuma zedoaria, Sparganium, Astragalus, and ginseng were combined in pairs with the proportion of 1:2, 1:1, 2:1. There were 13 couplet medicines of reinforcing qi and activating blood. Serum pharmacological method was used to prepare medicated serum of the couplet medicines of reinforcing qi and activating blood. Scratch method was used to detect the effect of medicated serum of these couplet medicines of reinforcing qi and activating blood and activate blood herbs on the migration a-bility of HUVEC (with the density of 5í105/mL) after 24 hours. The results showed that compared with the blood serum of the blank group, the Cortex moutan group, Ligusticum chuanxiong group, Paeonia group, Salvia and Astra-galus (1:2) group, Salvia and Astragalus (1:1) group, Ligusticum chuanxiong and Astragalus (1:2) group had obvious promoting effect on the migration ability of VEC (P < 0.05 or P < 0.01). The Sparganium group, curcuma zedoaria group, Cortex moutan group, curcuma zedoaria and Astragalus (2:1) group, Sparganium and ginseng (2:1) group, Spar-ganium and Astragalus (1:1) group had obvious inhibiting effect on the migration ability of VEC (P< 0.05 or P<0.01). It was concluded that different compatibility of medicines of reinforcing qi and activating blood and activate blood herbs had different promoting or inhibiting effect on migration ability of HUVEC. It may be related to the mechanism of action of these drugs on promoting or inhibiting angiogenesis at the cellular level.
RESUMEN
Objective To Investigate the influence of high-intensity pulsed electromagnetic field (HIPEMF) on neural differentiation of neonatal rats neural stem cells in vitro.Methods Neural stem cells (NSCs) were isolated from the subventricular zone of 3-day-old neonatal rats and cultured with serum-free condition medium for 14 days.All the NSCs were then randomly classified into an experimental group which received the stimulation of HIPEMF (0.1 Hz,4 T,8 pulses) and a control group which received no special intervention.Differentiation of the culture was induced by addition of 10％ fetal bovine serum on the first day after intervention,the morphological changes of cells were observed under the microscope at different time points.The NSCs adhered to the wall and differentiated for seven days,the immunofluorescence was employed to observed and calculate the ratio of differentiated cells with astrocyte marker GFAP or neuronal markers TUJ1.RT-PCR and western blotting were used to measure the expression levels of the differentiated cells based on gene and protein levels,respectively.Results Immunofluorescence staining showed the number of TUJI positive cells in the experimental group(33.4％ ± 5.1％)was significantly more than the control group (26.5％ ± 7.0％),while the number of GFAP positive cells was decreased(23.9％ ± 5.0％) as compared with the control group(36.2％ ± 2.2％).RT-PCR showed that the TUJ1 mRNA expression levels in the experimental group was (1.682 ± 0.086) times of the control group.Western blot showed that the expression of TUJ1 (0.729 ±0.061) in the experimental group was higher than in the control group (0.590 ± 0.157),while the expression of GFAP in the experimental group (0.566 ± 0.056) was less than in the control group(1.034 ± 0.051).Conclusions HIPEMF facilitates differentiation of neural stem cells to neurons,at the cost of reducing astrocytic differentiation.