Objective To study the dynamic changes of anatomy and the dosimeter distribution those changes influenced. Methods Initially simplified intensity modulated radiation therapy (sIMRT)were performed to twenty-nine patients with phase Ⅲ - Ⅳa esophageal carcinoma from January 2007 to March 2009. The target volumes and involving organs were contoured on the primary spiral CT pictures.After sIMRT planning being finished, secondary CT scan was acquired to rectify the treatment center. For eleven patients at every other week and eighteen patients at the fourth week, spiral CT images were acquired according to the same treatment center, and thereafter fused with the first CT images. Firstly, the law of change and the best time of replanning were searched:the changed gross tumor volume (GTV), gross node volume (GTVnd), plan target volume (PTV) and normal organs (lung, spinal cord, heart and outline) on the fusion interface were modified by a single physician, the changes for each structure throughout treatment were measured by system software. Secondly, dose distributions were computed and evaluated for replanning CT using the same beams arrangement as the initial plan. Cumulative dose was estimated using weighted average and compared with the original plan. Results For eleven patients, The law of change:the volume of outlines and GTV gradually decreased, and the change come to peak in the fourth week. The conformal index for PTV gradually decreased, whereas the heterogeneous index gradually increased. For twenty-nine patients on the fourth week, the dose of GTV were more than 60 Gy. The dose of PTV-D95 and CTV-D99 decreased ( t = 1.49, P = 0. 147 and t = 2. 07, P = 0. 048 respectively). The dose of CTV-D99 in two patients deceased to 54 Gy or less. The cord-Dmax and lung V30 increased significantly ( t = - 2. 42, P = 0. 022 and t = -2. 26,P =0. 032). Conclusions During the course of sIMRT for esophageal cancer, the volume of GTV decreased and the change come to peak in the fourth week. It is the best time for evaluating the change of dose of target volume using CT-CT fusion. For some patients, revise of the treatment plan is needed to ensure adequate target volume dosage and safety of normal tissues.

Objective To investigate the histopathological and ultrastructural changes of corneal epithelium induced by erlotinib in mice.Methods Totally 30 6-8 weeks old male BALB/c mice were divided into three groups:Control group (n =12),experimental group (n =12),another 6 mice did nothing as the blank control.Experimental group used erlotinib eye drops and control group used PBS in both eyes,four times per day.At 1 day,7 days and 14 days after the intervention,corneal fluorescence staining (FL) was observed by slit lamp and graded.On the fourteenth day after the intervention,the eye balls of mice were taken,and the histopathological and ultrastructural changes of corneal epithelium and epithelial cells were observed by optical microscope and electron microscope,respectively.And protein of cornea was measured by Western Blot.Results Before the intervention,there was no significant difference in FL scores between the experimental group and control group (P ＞ 0.05).At 1 day,7 days and 14 days,FL score of experimental group was significantly higher than the groups of non-intervention,the difference was statistically significant (all P ＜ 0.05).While FL score of control group was not statistically significant before and after intervention (all P ＞ 0.05);Compared between two groups,there were statistical differences at 7 days,14 days in FL score (all P ＜ 0.05).In the experimental group,the histopathological changes of murine corneal epithelial cells had disorderly arrangement,increased layers of cells,and the inflammatory cells.Under electron microscope,the morphology of corneal epithelial surface cells was irregular and partially detached.The number of microvilli,desmosomes and hemidesmosomes were significantly decreased when compared to the control group.The expression of p-EGFR in experimental group was significantly less than that in control group,the difference was statistically significant (P ＜ 0.05).Conclusion Erlotinib can damage the tissue structure of corneal epithelium and ultrastructure of corneal epithelial cells in mice.And the mechanism is probably that erlotinib influence the corneal epithelium by inhibiting the EGFR activation.

Circadian rhythms play crucial roles in orchestrating diverse physiological processes that are critical for health and disease.Dysregulated circadian rhythms are closely associated with various human metabolic diseases,including type 2 diabetes,cardiovascular disease,and non-alcoholic fatty liver disease.Modern lifestyles are frequently associated with an irregular circadian rhythm,which poses a significant risk to public health.While the central clock has a set periodicity,circadian oscillators in peripheral organs,particularly in the liver,can be entrained by metabolic alterations or stress cues.At the molecular level,the signal transduction pathways that mediate stress responses interact with the key determinants of circadian oscillation to maintain metabolic homeostasis under physiological or pathological conditions.In the liver,a number of nuclear receptors or transcriptional regulators,which are regulated by me-tabolites,hormones,the circadian clock,or environmental stressors,serve as direct links between stress responses and circadian metabolism.In this review,we summarize recent advances in the understanding of the interactions between stress responses(endoplasmic reticulum stress response,oxidative stress response,and inflammatory responses)and circadian metabolism,and the role of these interactions in the development of metabolic diseases.

Objective To research the effect mechanism of ultrashortwave in the correlation of ultrashortwave and the tail replantation, provide the experiment basis of clinical practice of prevention and cure for the vascular crisis after micromodule anastomosis. Methods Eighty Sprague-Dawley(SD) rats of clean grade were 3-month-old,female,and were divided into four groups:control group (group 0),model group (group 1 ),contrast group (group 2),ultrashortwave (USW) group (group 3).The preparation of tail replantation model was cut off soft tissue except for caudal veins on both sides of the tail. The coccyx was not broken away from tail.At last,the audal artery under abdominal main centre ditch was anastomosed.In experiment process, the USW group was divided into high dosage group (group 3A) and low dosage group (group 3B). The caudal arterys were ligated and not anastomosed in the group 0. Caudal arterys in other groups were anastomosed.Rats in the group 0 and group 1 received no treatment,normal management after the operation. Rats in the group 2 were given abdominal cavity injection of papaverin liquid immediately,then once a day to 5 days after the tail replantation.Rats in the group 3 were immediately given USW therapy of twenty minutes on the anastomosis section,and then once a day for 5 days after the tail replantation.The USW dosage of group 3A was 3th grade and 50mA. The USW dosage of group 3B was 2th grade and 28mA.The survival rate of the rat tails was observed after the tail replantation for 10 day.Before being grouped,it was measured that the tail skin temperature diference between near and far side of anastomosis section.After the tail relpantation, the temperature diference was inspected daily for 10 postoperative days hence. Before rats were grouped and the eighth hour after the tail replantation, rats were collected blood plasma specimens and measured contents of nitric oxide with destination colorimetric mathods of nitric oxide.Results Carrying out comparison of survival rate of every group,the output weve:between tail cutting off group (group 0,0) and tail replantation group (group 1,2,3,43.94％) to compare P ＞ 0.05; between each group of the tail replantation groups (1,2,3A,3B group) to compare P＞ 0.05,group 3B ＜ 2 ＜ 1 ＜ 3A; between group 3B and group 1 to compare P ＞ 0.05; between group 2 and group 1 to compare P ＞ 0.05. Each group were compared with the change daily between postoperative and preceding operative the skin temperature diference,single-factor analysis of variance (One-Way ANOVA) analysis:Postoperative 1 day,group 3A ＜ 1,P ＜ 0.05.Postoperative 6 day:3A ＜ 3B ＜ 1 ＜ 2,P ＞ 0.05.Postoperative 7 day:group 3B ＜ 1 ＜ 3A ＜ 2,P ＜ 0.05.Each group were compared with the change of the content of nitric oxide between postoperative 8 hour and preceding operative,with rank-sum test:group 3B ＞ 3A ＞ 2 ＞ 1 ＞ 0,H =33.760,P ＜ 0.05,shows statistically significant.Conclusions USW therapy,especially USW low-dose therapy,can reduce vascular crisis and improve the survival rate of replanted rat tails,after the postoperative 1,6,7 days,reduce skin temperature,improve blood supply,improve nitric oxide at postoperative eighth hour,prevent vascular crisis.Rat tail replantation model in this experiment is feasible.

The validity of the recently recommended HbA1C criterion by the American Diabetes Association (ADA) in identification of dysglycemia in children with obesity was evaluated. 293 obese children underwent oral glucose tolerance test. Receiver operating characteristic ( ROC ) curve analysis was used to examine the sensitivity and specificity of fasting plasma glucose (FPG) and HbA1C in identifying dysglycemia. The results showed that the prevalence of type 2 diabetes mellitus (T2DM) was 3.8％ and prediabetes 16. 0％ based on plasma glucose standard. 4. 1％ and 25.6％ were categorized as T2DM and “at high risk of diabetes mellitus” based on both HbA1C and plasma glucose criteria. HbA1C was more efficacious than FPG in detecting abnormal glucose tolerance as shown by the areas under the curve in ROC of 0. 875 and 0. 713 respectively (P＜0. 01 ). The sensitivity and specificity were 60. 5％ and 86. 8％ at HbA1C ≥5.7％, and 30. 5％ and 94.0％ at FPG ≥ 5.6 mmol/L.

Objective:To explore whether there were changes in midbrain morphology related to motor function in patients with cerebral small vessel disease (CSVD).Methods:The study was conducted on a subset of patients with CSVD registered at the Department of Neurology of Peking Union Medical College Hospital from 2010 to 2018. All magnetic resonance imaging images were taken with a 3.0 T nuclear magnetic resonance imager. The measurement of anteroposterior diameter of the mesencephalon and the tegmentum of mesencephalon was performed on a personal computer with the image processing software RadiAnt DICOM Viewer. Several clinical manifestations of dyspraxia, dysphagia, dysarthria and dysuria were evaluated by interviewing the patient and family members living with the patient. Kinect depth camera combined with self-developed software platform was used to conduct quantitative evaluation of patients′ motor function. Three parameters, namely walking speed, walking time of three meters and time of standing up and sitting down, were selected from the obtained parameters. SPSS 17.0 software was used for statistical analysis.Results:A total of 176 patients were included, aged 30-88 (64.16±11.57) years. One hundred and fifteen patients were males, accounting for 65.34%. In patients with CSVD, anteroposterior diameter of the mesencephalon and the tegmentum of mesencephalon were negatively correlated with age ( B=-0.032, P<0.001; B=-0.020, P=0.006). The anteroposterior diameter of the mesencephalon was negatively correlated with symptoms of dyskinesia ( OR=0.006, 95% CI 0-0.135, P=0.001), even when the age and gender were adjusted ( OR=0.014,95% CI 0-0.416, P=0.013). The anteroposterior diameter of the mesencephalon was negatively correlated with symptoms of dysuria ( OR=0.046,95% CI 0.002-0.936, P=0.045), but no longer correlated when the age and gender were adjusted. The anteroposterior diameter of tegmentum of mesencephalo was also negatively correlated with symptoms of dyskinesia ( OR=0.035,95% CI 0.002-0.684, P=0.027), but no longer correlated after adjusting for age and gender. Video recording and evaluation of motor function were performed on 87 patients. Spearman correlation analysis showed that none of the three motor function scores was correlated with age or gender. The anteroposteric diameter of the midbrain was positively correlated with walking speed ( r=0.231 ,P=0.040) and negatively correlated with walking time of three meters ( r=-0.304, P=0.005), but not with standing up and sitting down time, while the anteroposteric diameter of tegmentum of mesencephalo was not correlated with all of them. Conclusion:There are changes in mesencephalon morphology in patients with CSVD, structural parameters of mesencephalon are related to motor function and urination function, and mesencephalon atrophy may be an independent related factor for symptoms of dyskinesia in patients with CSVD.

Gut microbiota and their metabolites like bile acid (BA) have been investigated as causes of irritable bowel syndrome (IBS) symptoms.Primary BAs are synthesized and conjugated in the liver and released into the duodenum. BA biotransformation by gut microbiota begins in the intestine and results in production of a broad range of secondary BAs. Deconjugation is considered the gateway reaction for further modification and is mediated by bile salt hydrolase, which is widely expressed by the gut microbiota. However, gut bacteria that convert primary BAs to secondary BAs belong to a limited number of species, mainly Clostridiales. Like gut microbiota modify BA profile, BAs can shape gut microbiota via direct and indirect actions. BAs have prosecretory effects and regulates gut motility. BAs can also affect gut sensitivity. Because of the vital role of the gut microbiota and BAs in gut function, their bidirectional relationship may contribute to the pathophysiology of IBS. Individuals with IBS have been reported to have altered microbial profiles and modified BA profiles. A significant increase in fecal primary BA and a corresponding decrease in secondary BA have been observed in IBS with predominant diarrhea. In addition, primary BA was positively correlated with IBS symptoms. In IBS with predominant diarrhea, bacteria with reduced abundance mainly belonged to the genera in Ruminococcaceae and exhibited a negative correlation with primary BAs. Integrating the analysis of the gut microbiota and BAs could better understanding of IBS pathophysiology. The gap in this field needs to be further filled in the future.

Purpose:To investigate the management and prognosis of urethral calcali.Methods:46 case of urethral calculi have been studied and followed up, 45 cases are males, 1 case is female. Mean age of the patients was 41 years. All patients complained of dysuria and urinary pains, acute retention was present in 10 cases. 3 cases have haematuria. Associated urethral disease was found in 12 patients.Results:The 37 cases were treated by endoscopic manipulation of choice for urethral calculi and have been followed up and have been all recovered except only 1 case.Conclusions:Endoscopic manipulation was found to be the safest and the most effective procedure.

Objective To investigate the genotype distribution of thalassemia intermedia , major and compound thalassemia in Peking Union Medical College Hospital from 2012 to 2015. Methods Retrospectively 1 084 suspected thalassemia cases were analyzed in recent four years .Three common deletions of αglobin chain were detected by GAP-PCR.Three common point mutations of αglobin chain and seventeen common mutations of βglobin chain were identified by PCR reverse dot blot hybridization . Hemoglobin electrophoresis was carried out by Capillary Electrophoresis System .RBC associated parameters and morphology were analyzed by hematology analyzer and blood smear .Results 702 cases were confirmed to be thalassemia, and the positive rate was 64.76% (702 /1084).19 types of gene defects were detected. There were 4 types of gene defects in 23 case with α-thalassemia intermeida, including -α3.7 /--SEA , -α4.2 /--SEA , αCSα/--SEA and αQSα/--SEA , -α3.7 /--SEA to be the most common genotype (18 cases) .3 cases with β-thalassemia intermeida were confirmed and the genotypes were βCD 17(A→T) /β-29(A→G) , β-28(A→G) /β-28(A→G) andβIVS-Ⅱ-654(C→T) /βCD17(A→T) , respectively.There were also 1 βCD 41 -42(-TTCT) /βCD17(A→T) thalassemia major case. The genotypes of 2 HbE/β-thalassemia cases were βCD41 -42(-TTCT) /βE and βCD17(A→T) /βE.5 αβ-thalassemia including 2 βCD 41 -42(-TTCT) /βA compounded with αα/-α3.7 , 1βIVS-Ⅱ-654(C→T) /βA compounded with --SEA /αCSα, 1βCD17(A→T) /βA compounded with -α4.2 /ααand 1βCD 41 -42(-TTCT) /βA compounded with αCS α/αα.Rare and untypical haematological results were found , such as normal level HbA 2 and undetectable HbH, in compound heterozygosity with --SEA /αCS α and βIVS-Ⅱ-654(C→T) /βA. Conclusions The genotypes of thalassemia intermedia, major and compound thalassemia in Peking Union Medical College were highly variable .

Objective To compare the indexes related to monitoring of iodine deficiency disorders between Xianyang City of Shaanxi Province and Yinchuan City of Ningxia Autonomous Region in 2016 for providing a basis in evaluating control measures to iodine deficiency disorders. Methods In 2016, 13 counties (districts) in Xianyang City and 6 counties (districts) in Yinchuan City were conducted sample surveys in accordance with the requirements of the"National Iodine Salt Monitoring Program", and the surveillance results were analyzed. The main indicators included salt iodine content, urinary iodine content in children aged 8 - 10 and pregnant women and children's goiter rate. Salt iodine content was measured by direct titration according to the "Determination of Iodine in General Test Method for Salt Industry" (GB/T 13025.7-2012). Urinary iodine content was determined using arsenic cerium catalytic spectrophotometry (WS/T 107-2006). Children's goiter was determined by B-ultrasound examination based on the "National Diagnostic Criteria for Endemic Goiter" (WS 276-2007). Results In 2016, Xianyang City and Yinchuan City had monitored 3900 and 1800 salt samples, respectively, the medians of salt iodine were 30.2 and 27.8 mg/kg, respectively. The median of salt iodine in Xianyang City was higher than that in Yinchuan City (Z = 14.58, P < 0.05); non-iodized salt rate (0.18％, 7/3900), unqualified iodized salt rate (0.72％, 28/3900) in Xianyang City were lower than those in Yinchuan City (0.56％, 10/1800;1.50％, 27/1800; χ2=5.86, 7.88, P<0.05), and qualified salt iodide consumption rate in Xianyang City (99.10％, 3865/3900) was higher than that in Yinchuan City (97.94％, 1763/1800, χ2 = 13.24, P < 0.05). The median of urinary iodine in children in Xianyang City (247.75 μg/L) was higher than that in Yinchuan City (223.70 μg/L, Z = 21.04, P < 0.05), and the ratio of urinary iodine < 100 μg/L in Xianyang City (11.92％, 310/2600) was lower than that in Yinchuan City (15.08％, 181/1200, χ2= 7.29, P < 0.05). The median of urinary iodine in pregnant women in Xianyang City (176.86 μg/L) was lower than that in Yinchuan City (187.70 μg/L, Z = 7.33, P < 0.05), and the ratio of urinary iodine < 150 μg/L in Yinchuan City (38.50％, 231/600) was higher than that in Xianyang City (32.00％, 416/1300,χ2=7.72,P<0.05). The thyroid palpate swelling rates of children in Xianyang City and Yinchuan City were 1.94％(53/2730) and 2.22％ (28/1260), respectively, the rates between the two cities was not statistically significant (χ2=0.34, P > 0.05). Conclusions The monitoring indexes of iodine deficiency disorders in Xianyang City and Yinchuan City have reached the national standard for eliminating iodine deficiency disorders. In comparison, Yinchuan City should further strengthen the monitoring of iodine nutrition level in children and pregnant women, iodized salt market supervision and health education.