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BackgroundIn relation to neurodevelopmental hypothesis in the etiology of schizophrenia， brain-derived neurotrophic factor （BDNF） as a neurotrophin occupies a relatively dominant position in neuronal development and is a potential biomarker for schizophrenia， and previous studies have suggested that its serum concentration and genetic polymorphisms play a vital role in the pathogenesis of schizophrenia， but this remains controversial. ObjectiveTo analyze the difference in BDNF serum concentration between schizophrenic patients and healthy controls， and to explore the correlation of three BDNF single nucleotide polymorphism （SNPs） including rs11030101， rs2030324 and rs6265 with BDNF serum concentration and clinical symptoms in patients with schizophrenia， thus providing references for the clinical treatment of schizophrenia. MethodsA case-control study was conducted on 55 patients with schizophrenia who attended the Zhongshan Third People's Hospital from January 2019 to December 2020 and met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）， and 31 healthy controls concurrently recruited from the hospital or general population. Positive and Negative Symptom Scale （PANSS） was utilized to evaluate the psychiatric symptoms of patients with schizophrenia. BDNF serum concentration in all participants was measured using enzyme-linked immunosorbent assay （ELISA）， and the genotype distributions of three BDNF SNPs （rs11030101， rs2030324， rs6265） were investigated by polymerase chain reaction sequence-based typing method. ResultsBDNF serum concentration in patient group was lower than that in control group， with statistical difference （t=-3.804， P<0.01）. In terms of clinical symptoms， PANSS total score， excitement/hostility domain score， and depression/anxiety domain score demonstrated statistical difference among patients with different genotypes at SNP rs11030101 （t=2.022， Z=-2.696， -2.467， P<0.05 or 0.01）. No statistical difference was noted in BDNF serum concentration in patients with different genotypes at three BDNF SNPs （Z=1.483， F=2.584， 0.417， P>0.05）. ConclusionPatients with schizophrenia are found to have low BDNF serum concentration， and the three BDNF SNPs （rs11030101， rs2030324， rs6265） are not associated with BDNF serum concentration， whereas the BDNF rs11030101 polymorphism may contribute to the manifestation of clinical symptoms of excitement/hostility and depression/anxiety in patients with schizophrenia. Furthermore， BDNF serum concentration seems to be more dependent on clinical diagnosis effect rather than genetic polymorphism. ［Funded by Guangdong Province Medical Science and Technology Research Fund Project （number， A2021205）； Zhongshan Medical Research Program （number， 2022J221）］
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Objective:To explore the feasibility of low-dose 4DCT scanning in simulation and target delineation for solitary pulmonary tumors (SPTs).Methods:23 patients with SPTs received 4DCT scanning simulation with the conventional scanning (CON), low voltage (LV), low current (LA) and low voltage combined with low current (LVA) in sequence. Based on the 4DCT images derived from the four sets of scanning parameters, the internal gross tumor volume (IGTV CON, IGTV V, IGTV A, IGTV VA) of SPTs were delineated and matched. Taking IGTV CON as reference, the tumor displacement and the centroid position of IGTV V, IGTV A and IGTV VA were compared with IGTV CON. The radiation doses under different scanning parameters were compared. Results:The volumes of IGTV CON, IGTV V and IGTV A were (12.26±12.30) cm 3, (12.21±12.16) cm 3 and (11.87±11.70) cm 3, respectively ( P=0.337). IGTV VA was (11.34±11.07) cm 3, significantly smaller than IGTV CON ( P=0.005). There was no significant difference in the centroid positions of IGTV CON, IGTV V, IGTV A and IGTV VA in three directions ( P=0.491, 0.360, 0.136). The Dice′s similarity coefficient (DSC VA) was significantly lower than DSC V and DSC A ( P=0.004, 0.030). The tumor displacement measured by the four sets of 4DCT images was similar in the LR direction ( P=0.470), and also in the AP direction ( P=0.108). For the displacement in the SI direction, LVA scanning was smaller than CON ( P=0.015). The radiation doses under four different scanning conditions were (397.0±140.3) mGy·cm, (175.0±61.8) mGy·cm, (264.8±95.3) mGy·cm and (116.8±41.2) mGy·cm, respectively ( P<0.001). Conclusions:LV or LA scanning exert no significant effect on the volume, centroid position of IGTV and the tumor displacement in 4DCT simulation for SPTs. The radiation dose that patients receive under LV and LV scanning is lower than that of CON. Consequently, LV or LA scanning is feasible in 4DCT simulation and target delineation for SPTs.
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Hypertension is an important risk factor for the morbidity and mortality of cardiovascular and cerebrovascular diseases. Improving compliance is the key to the prevention and control of hypertension in community. This paper summarizes the improvement of compliance of patients with hypertension， analyzes the ideas and feasibility of assisting hypertension community prevention and control from three aspects： improving medication compliance， improving behavior compliance and digital intelligent management， and puts forward corresponding suggestions to improve the compliance of patients with hypertension.
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Children with pediatric tumors have better prognosis and longer survival than adults, suggesting that attention should be paid to the long-term complications induced by radiotherapy. In this article, the data from more than 40 clinical studies of pediatric tumor radiotherapy published in the recent decade were retrospectively analyzed. Long-term complications of nervous system, cardio-cerebrovascular system, respiratory system, endocrine system, urinary system, reproductive system, skeletal development, long-term secondary tumors were considered and the corresponding radiation dose-volume parameters were summarized, aiming to guide radiation oncology physicians and physicists to optimize radiotherapy plans for children with pediatric tumors.
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In recent years, immunotherapy has become the hottest topic in the field of oncology. Both the Keynote189 study and the Keynote407 study have confirmed that progression-free survival is significantly prolonged in patients who have been benefited from immune checkpoint blockades in lung cancer. In an article published in The New England Journal of Medicine in 2012, a case report of radiation abscopal effects caused by immunization combined with conventional radiotherapy has attracted great attention in the field of oncology. The Pacific study, published in 2017, expanded the indications for immunotherapy from advanced to locally-advanced non-small cell lung cancer. The second analysis of Keynote001, published in the Lancet Oncology in the same year, suggested that radiation therapy may mediate the immune memory effects, whereas the mechanism and time window are still unclear. With the publication of PEMBRO-RT study and several pieces of work by our team in recent years, various details of radiotherapy combined with immunotherapy (iRT) have become more mature. In clinical practice, iRT is involved in the full treatment of lung cancer. However, iRT is not a hodgepodge or stew that needs further refinement and sorting. In this article, the principles, efficacy in clinical practice, and exploration of the details of iRT were discussed.
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In recent years, unconventional fractionated radiotherapy has shown increasing advantages in the treatment of multiple system tumors. Simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) involves the delivery of standard-fraction doses of radiotherapy to different areas, achieving the delivery of higher doses of radiotherapy per fraction to the high-risk gross tumor volume (GTV) without sacrificing the irradiation dose to the normal tissues. The dosimetric advantages of SIB-IMRT have been widely recognized. At present, the local control, survival advantage, indication population and the optimal upper limit of single fraction of SIB-IMRT for esophageal carcinoma are still unclear. This article reviews the application of SIB-IMRT in esophageal carcinoma.
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Multi-disciplinary team(MDT)mode is regarded as the key to standardized diagnosis and treatment of malignant tumors. The model, however, encounters such roadblocks in the current form of MDT organization, as costly clinical resources and time consumption, low efficiency, poor management of participating experts in MDT, and lack of enforceability of the therapeutic decisions made. This paper summarized the practical MDT experiences of the Affiliated Cancer Hospital of Shandong First Medical University. It introduced the construction of an intranet-based MDT system covering a large proportion of newly diagnosed malignant tumor patients, and the practices and achievements of such MDT management system under hospital administrative guidance. The authors proposed to use reporting ratio as the main assessment indicator in promoting MDT, and that to define the performance, responsibilities and rights in MDT practice. These measures aim at to upgrading individual behaviors of doctors to organizational behaviors of hospitals, and providing cancer patients with more standardized, comprehensive and personalized diagnosis and treatment decisions.
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Objective:To measure the displacement of the solitary pulmonary lesion (SPL) located in different pulmonary segments based on 4D-CT technology (4DCT) and to establish and verify a relevant mathematical model of tumor displacement.Methods:The modeling samples of 290 SPLs were subject to both 4DCT and active breath control (ABC) spiral CT scans. The tumor displacement in different pulmonary segments was measured based on 4DCT images. The tumor volume was obtained by contouring the gross tumor volume (GTV) on ABC spiral CT images. The diaphragm movement was measured by X-ray simulator. The vital capacity and tidal volume were gained by pneumatometer. The baseline data, such as gender, age, height, weight, respiratory rate, and tumor lobe and segment where tumors were located, were collected. Multivariate linear regression was used to analyze the correlation between the 3D-tumor displacement and gender, age, height, weight, respiratory rate, tumor location, volume and diaphragm movement. The displacement model was established based on the modeling sample of 290 cases. Then, it was verified by comparing the tumor displacement derived from the model with that of 4DCT technology based on the randomly selected 17 SPLs.Results:The displacement model for tumors located in the upper lobe was established as Xup=-0.267+0.002TV+0.446DM, Yup=-1.704+0.004TV+0.725DM+2.250SII+1.349SIII and Zup=0.043+0.626DM+0.599SII+0.519SIII. The displacement model of the middle lobe tumors was Xmid=0.539+0.758DM, Ymid=-2.316+2.707DM+0.009TV and Zmid=0.717+1.112DM. The displacement model for tumors located in the lower lobe was Xlow=-0.425+0.004TV+0.857DM, Ylow=4.691+4.817DM+0.005TV-0.307RR+3.148SIX+2.655SX and Zlow=0.177+0.003TV+0.908DM.(DM: diaphragm movement, TV: tidal volume, RR: respiratory rate, SII: posterior segment, SIII: anterior segment, SIX: lateral basal segment, SX: posterior basal segment). There was no significant difference between two results derived from the displacement model and 4DCT technology.( P>0.05). Conclusions:The diaphragm movement and tidal volume are the main influencing factors of 3D lung tumor displacement. The tumor displacement in the superior-inferior direction is correlated with different pulmonary segments of the upper and lower lobes. The displacement of tumors located in different segments of middle lobes is similar. The displacement model can predict the displacement of SPLs located in different lobes, providing reference for individualized delineation of PTV.
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Since the establishment of the Chinese Society of Therapeutic Radiation Oncology 33 years ago, radiation oncology has developed rapidly in China. Based on previous survey data, this paper summarizes and reviews the development of radiation oncology in China (excluding Hong Kong, Macao and Taiwan regions) from the perspectives of radiotherapy units, relevant professionals, equipment, technologies and subject development, and looks forward to the future direction, and proposes a new concept—" precision radiotherapy" .
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Objective@#To analyze the effect of epigallocatechin-3-gallate (EGCG) in radiation induced esophagitis of model rabbit.@*Methods@#Thirty male New Zealand rabbits were randomly divided into EGCG group, saline group, blank group. The rabbits in EGCG and saline groups were irradiated with 6 MV X-rays. The blank group did not receive radiation. After irradiation, rabbits were given with 440 μmol/L EGCG or saline three times a day in continuous 5 days. The scores of pathological changes of esophagus were observed by optical microscope.The serum levels of interleukine-1 beta (IL-1β), interleukine-6 (IL-6), transforming growth factor-β (TGF-β) and tumor necrosis factor-α (TNF-α) were detected by enzyme linked immunosorbent assay. The expression levels of 67KD laminin receptor (67LR) was detected by immunohistochemistry.@*Results@#After treatment, the scores of pathological changes of esophagus in blank group, saline group, EGCG group were 0, 3.9±1.10 and 2.80±0.92, respectively. At different time points after drug treatment, the levels of serum inflammatory factors among three groups were significantly different (F=23.66-236.32, P<0.05). The expressions of 67LR in esophageal tissue of 3 groups were also significantly different (F=585.38, P<0.05).@*Conclusions@#EGCG reduced radiation-induced esophagitis in rabbits by decreasing the levels of serum inflammatory factors, which may be related to the expression of 67LR protein.
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Objective To analyze the effect of epigallocatechin-3-gallate (EGCG) in radiation induced esophagitis of model rabbit.Methods Thirty male New Zealand rabbits were randomly divided into EGCG group,saline group,blank group.The rabbits in EGCG and saline groups were irradiated with 6 MV X-rays.The blank group did not receive radiation.After irradiation,rabbits were given with 440 μmol/L EGCG or saline three times a day in continuous 5 days.The scores of pathological changes of esophagus were observed by optical microscope.The serum levels of interleukine-1 beta (IL-1β),interleukine-6 (IL-6),transforming growth factor-β (TGF-β) and tumor necrosis factor-α (TNF-α) were detected by enzyme linked immunosorbent assay.The expression levels of 67KD laminin receptor (67LR)was detected by immunohistochemistry.Results After treatment,the scores of pathological changes of esophagus in blank group,saline group,EGCG group were 0,3.9± 1.10 and 2.80±0.92,respectively.At different time points after drug treatment,the levels of serum inflammatory factors among three groups were significantly different (F=23.66-236.32,P＜0.05).The expressions of 67LR in esophageal tissue of 3 groups were also significantly different (F=585.38,P＜0.05).Conclusions EGCG reduced radiationinduced esophagitis in rabbits by decreasing the levels of serum inflammatory factors,which may be related to the expression of 67LR protein.
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With the development of programmed death-1 (PD-1) and programmed death ligand-1 (PD-L1) inhibitors,the second generation of combined immunosuppressive agents emerge as the times require.As a bifunctional anti-PD-L1/transforming growth factor-β (TGF-β) fusion protein,M7824 can antagonize PD-L1 pathway and trap TGF-β at the same time,which can effectively enhance the immune response and reduce the occurrence of immune escape and drug resistance.The drug has achieved remarkable results in many preclinical studies,however,the indications,safety and efficacy still need to be confirmed by large-scale clinical research data.
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Modern medical imaging techniques,such as computed tomorgraphy (CT),magnetic resonance imaging (MRI) and position emission tomorgraphy/computed tomorgraphy (PET-CT) can accurately delineate the gross target volume (GTV) of hepatocellular carcinoma (HCC).Comparison of postoperative pathological subclinical lesions,imaging and clinical parameters contributes to the precise delineation of clinical target volume (CTV).Moreover,radiotherapy-assisted techniques,such as fourdimensional computed tomography (4DCT),compression of abdomen,active breathing control and respiratory gating,can minimize the internal target volume (ITV).In addition,immobilization with vacuum cushion and body membrane can reduce the set-up error,minimize the planning target volume (PTV) and avoid or decrease the irradiation error or missing irradiation.All these approach can minimize the target volume,elevate the dose and reduce the complications during radiotherapy for HCC.In this article,the research progress on the target delineation for external beam radiotherapy in HCC patients was reviewed.
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Health literacy has become a vibrant area of research, and the nutrition literacy and health literacy were closely related as well as a growing number of inquiries have focused on direct measures of nutrition literacy. In this paper, we summarized some features such as the structure, the content, the reliability, the validity and the application of the general nutrition literacy assessment tools and the health literacy assessment tools related to nutrition literacy, furthermore the evaluation contents were listed as the understanding capacity, numeracy capacity, household food measurement, food group, and basic nutrition knowledge. In addition, the briefly the nutrition information readability assessment tools were also summarized. The research results of nutritional literacy and its assessment tools would provide reference for the development of nutrition literacy assessment tools and evaluation work in China.
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Objective:To test the validity and reliability of the Perceived Stress Scale-14 items (PSS-14) applied in cancer survivors.Methods:Totally 652 cancer survivors (patients who had finished active treatments and were in convalescence) were selected and a field questionnaire survey was conducted among them.Exploratory factor analysis and confirmatory factor analysis were performed to test the construct validity of PSS-14.Correlation between the two dimensions (discriminant validity) and correlation between stress and quality of life were analyzed to further test its validity.The intemal consistency reliability,split-half reliability,retest reliability and sensitivity analysis were adopted to test the reliability of PSS-14.Results:Two common factors were extracted in the exploratory factor analysis.The cumulative percentage of variance explained was 60.8％.The index of confirmatory factor analysis were:TLI =0.92,CFI =0.93,SRMR =0.07,RMSEA =0.08.The correlation coefficient between the two dimensions of PSS-14 was-0.16 (P ＜0.001).The correlation coefficients between the score of PSS-14 and each dimension of EORTC QLQ-C30 were 0.24-0.55 (P ＜ 0.001).The Cronbach α coefficients of the whole scale and the two dimensions named "perceived coping ability" and "perceived distress" were 0.78,0.91 and 0.88 respectively.After the scale was split into two parts,the Cronbach α coefficients of each part were 0.66 and 0.60.The Spearman-Brown coefficient was 0.79.The Guttman split-half coefficient was 0.79.After one item was removed from the scale each time,the Cronbach a coefficients of the remaining items varied from 0.75 to 0.77.The retest reliability of the whole scale and the two dimensions were 0.89,0.86 and 0.85 respectively.Conclusion:PSS-14 shows favorable validity and reliability,suggesting the utility to assess stress of cancer survivors as a self-administered inventory.
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Surgical resection or liver transplantation are the primary curative treatments for hepatocellular carcinoma(HCC).However, a minority of patients are eligible for these treatment strategies upon initial diagnosis.With the development of radiotherapy technol-ogy,radiotherapy is being used increasingly in the treatment of HCC.A large number of studies have shown that external beam radio-therapy has obvious advantages for different stages of HCC.Stereotactic radiotherapy provides an alternative to radiofrequency abla-tion in the treatment of early unresectable HCC,and radiotherapy combined with other local or systemic treatments,including trans-catheter arterial chemoembolization and sorafenib,has been applied for the treatment of locally advanced and distant metastatic le-sions.The particle beam has the advantages of Bragg peak and better dose distribution compared to conventional radiography,show-ing promising prospect in clinical application.This review focuses on the developments in the field of external beam radiotherapy in the treatment of HCC.
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Circulating tumor cells (CTCs)are cancerous cells that shed from the primary tumor or metastases into the bloodstream. The currently clinical applicability of CTCs approved by the US Food and Drug Administration (FDA)is that CTCs can be prognostic biomarker for patients with metastatic breast cancer, prostate cancer and colorectal cancer. CTCs also have great potential in the prognosis assessment of other meta-static or localized tumors,as well as early screening of tumors,analysis of molecular profiling,guiding treat-ment decisions,and monitoring of treatment response. Currently,various studies are being carried out to further explore the clinical application of CTCs,and provide new strategies and new prospects for individualized and precise treatment of cancer patients.
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Female breast and gynecologic cancer affect sexual health of the survivors due to the disease itself and related treatment,resulting in sexual dysfunction and the reduced quality of life.The sexual dysfunction of patients is often overlooked,and the related interventions are less frequently mentioned.This article reviews the classification,influencing factors and interventions of sexual dysfunction in survivors of female breast cancer and gynecologic cancer,and also proposes the effective interventional strategies.
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Response evaluation criteria in solid tumors is widely used for assessing tumor response to radiotherapy in clinical practice.However,it is clearly insufficient.Currently there is no ideal method for early evaluation of tumor radiation response.This paper reviews studies on early evaluation of radiotherapy efficacy by positron emission tomography-computed tomography (CT),magnetic resonance imaging,and CT.This paper also further explores the necessity and feasibility of CT values of megavoltage CT scans in early evaluation of the radiosensitivity of tumor during tomotherapy.
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Rectal cancer is one of the common cancers which poses a threat to the health of mankind. In recent years. Multi-modality treatment strategies for locally advanced rectal cancer improve the treatment efficiency. Accurate prediction of the treatment response after the neoadjuvant chemoradiotherapy (CRT) can guide more suitable treatment strategy. MERCURY study proved the prognostic value of post-CRT standard morphologic MRI(T2-weighted) assessment of tumor regression grade(TRG), and MRI assessment of circumferential resection margin can guide the definitive surgery. Compared with standard morphologic MRI (T2-weighted), functional MRI, including diffusion weighted imaging (DWI) and dynamic contrast enhanced (DCE) MRI, has shown more promising results for the prediction of therapeutic response in rectal cancer. The addition of diffusion-weighted images to T2-weighted images improves the accuracy of restaging examinations for determination of complete pathologic responders. DCE can reflect the tumor micro-vascular environment, and the change of perfusion in response to treatment. These images have the potential to improve the accuracy of therapeutic response in rectal cancer.