ObjectiveTo evaluate the efficacy of hypertonic saline (HS) treatment in cardiopulmonary resuscitation (CPR) in animal models of cardiac arrest (CA).Methods PubMed and EMBASE data were retrieved from January 1st, 1966 to September 30th, 2014, and Wanfang data and CNKI were searched from January 1st, 1990 to September 30th, 2014 for randomized controlled trials (RCTs) regarding CPR intervention of CA animal models with HS. HS was intravenously infused at the initiation of CPR in HS group, without limiting its dosage or concentration. The same volume of normal saline (NS) was given in NS group. Meta-analysis concerning the rate of restoration of spontaneous circulation (ROSC), the serum sodium concentration before CA and during CPR, and related hemodynamic parameters, including mean arterial pressure (MAP) and coronary perfusion pressure (CPP) at the immediate beginning of CPR and 90 minutes after ROSC was conducted by RevMan 5.3 software.Results A total of 8 RCTs were included. Meta-analysis showed that compared with NS group, the rate of ROSC [relative risk (RR) = 1.23, 95% confidence interval (95%CI) = 1.05-1.43,P = 0.010], serum sodium concentration during CPR [weight mean difference (WMD) =17.44, 95%CI = 12.57-22.31,P< 0.01], and the level of MAP at 90 minutes after ROSC (WMD = 4.81, 95%CI =1.58-8.03,P = 0.003) were significantly improved in HS group. There was no significant statistic difference in other hemodynamic parameters, including serum sodium concentration before CA (WMD = 0.78, 95%CI = -0.26-1.82,P =0.14), MAP (WMD = 5.43, 95%CI = -0.74-11.59,P = 0.08) and CPP at the immediate beginning of CPR (WMD =6.82, 95%CI = -5.54-19.19,P = 0.28), and CPP at 90 minutes after ROSC (WMD = -0.77, 95%CI = -10.33-8.80, P = 0.88) between two groups. It was showed by funnel chart that bias was not significant in the published articles. Conclusion This systematic review indicates that HS infusion is followed by an improved ROSC rate, serum sodium concentration during CPR, and MAP at 90 minutes after ROSC in animal models of CA.

Objective To investigate the design and manufacture of 3D printed compensator in electron radiation therapy for Merkel cell carcinoma,and to verify the feasibility of this technique in electron radiation therapy.Methods Computed tomography was used to collect images of a human head phantom.The delineation of target volume of Merkel cell carcinoma was simulated in the planning system and a radiotherapy plan was formulated after adding the compensator.The compensator was printed out by a 3D printer and fixed on the head phantom.A second CT scan was performed to make a new treatment plan.For the two plans,several planes parallel to the beam were selected to calculate gamma passing rates.The actual dose distribution was measured using disposable films.The gamma passing rate was compared between the film system and the planning system.The conformity index (CI) and the heterogeneity index (HI) of target volume were compared between the plans using the printed compensator and the conventional compensator of the same thickness.Comparison between the two plans was made by paired t test.Results Using the dose distribution of the plan with simulated compensator,the gamma passing rate was 94.7±2.3％ in the plan with 3D printed compensator.Using the dose distribution measured by the film,the gamma passing rate was 96.6％ in the plan with 3D printed compensator.Compared with the conventional compensator,the 3D printed compensator achieved a significantly elevated CI (0.85 vs.0.69,P=0.004) and a slightly improved HI (1.30 vs.1.26,P=0.001).Conclusions The conformal dose distribution provided by 3D printed compensator for tumors at different depths meets the clinical need.

Objective To evaluate dose variations induced by gravity of multi-leaf collimator to provide references for clinical intensity-modulated radiotherapy.Methods Two-dimensional dose distributions in the central plane of IMRT fields were measured by use of a 2D ion chamber array.All measurements were repeated at two collimator angles (C=0 and 90°),for each of the following gantry angles:G=0 and 270°.Comparisons were made to dose distributions generated at G=0°and their differences were analyzed using gamma index analysis (3％/3 mm and 1％/1 mm).Results Under the radiation field of 10 cm×10 cm,the gamma passing rate was higher than 99％ for 3％ 3 mm anch close to 95％ for 1％/1mm Under a 3％/3mm error standard,the average matching rate for step & shoot fields was (96.46±0.33)％ and for DMLC fields was (94.67±0.54)％ at C=0°;The average matching rate for step & shoot fields was (94.59±0.47)％ and for DMLC fields was (92.60±0.52)％ at C=90°.Under a 1％/1mm error standard,the average matching rate for step & shoot fields was (89.83 ±1.06)％ and for DMLC fields was (85.84±0.57)％ at C=0°;The average matching rate for step & shoot fields was (86.91 ±1.71)％ and for DMLC fields was (83.89±0.69)％ at C=90°.Concusion MLC weight effect affects IMRT delivery dose,and DMLC fields are more sensitive to gravity than step & shoot fields.

BACKGROUND:Previous studies have found that electroacupuncture can delay articular cartilage degeneration mediated by JAK-STAT signaling pathway through upregulating the expression level of transforming growth factor β1 as well as mRNA expression levels of STAT3, Smad3 and LepR. In the meanwhile, electroacupuncture can inhibit the mRNA expression of p38 and Fas mRNA mediated by MAPK signaling pathways, further inhibiting the apoptosis of chondrocytes. OBJECTIVE: To explore the effect of electroacupuncture on the degeneration of articular cartilage in rats with knee osteoarthritis based on Ras-Raf-MEK1/2-ERK1/2 signaling pathway. METHODS:120 male healthy Sprague-Dawley rats aged 2 months olds were selected and randomly divided into normal, model, 15-minite electroacupuncture and 30-minute electroacupuncture groups (n=30 per group). The rats in the latter three groups received the intra-articular injection of 4% papain bilaterally, and the remaining rats received no intervention. At 2 weeks after modeling, the latter two groups were respectively given 15- and 30-minute electroacupuncture, five times weekly for consecutive 12 weeks. The morphology of the cartilage was observed by hematoxylin-eosin staining, the expression level of interleukin-1β in the synovium was detected by ELISA assay, and the protein expression levels of Ras, Raf, MEK1/2, ERK1/2, C-MYC, C-FOS, and C-JUN were detected by western blot analysis. RESULTS AND CONCLUSION: Hematoxylin-eosin staining showed that: in the model group, the cartilage surface was rough, the cartilage layer became thinner, and the cartilage structure was damaged with incomplete tidal line; in the 15- and 30-minute electroacupuncture groups, the cartilage structure was complete with clear layers and complete tidal line. ELISA showed that the expression level of interleukin-1β in the model group was significantly higher than that in the normal group (P< 0.01), and the level in the 15- and 30-minute electroacupuncture groups was significantly lower than that in the model group (P < 0.05). Western blot assay found that compared with the normal group, the protein expression levels of Ras, Raf, MEK1/2, ERK1/2, C-MYC, C-FOS, and C-JUN were increased in the model group. However, all above protein levels except ERK1/2 in the 15- and 30-minute electroacupuncture groups were significantly lower than those in the model group (P < 0.01,P < 0.05). To conclude, electroacupuncture inhibits the degeneration of articular cartilage in osteoarthritisvia Ras-Raf-MEK1/2-ERK1/2 signaling pathway and downregulating the expression level of interleukin-1β.

OBJECTIVETo investigate the expression and the distribution of human beta defensin (hBD)-4 in healthy gingiva.

METHODSHealthy gingival specimens were collected. The expression of hBD-4 peptides in 18 gingival specimens were detected by immunohistochemistry. The hBD-4 mRNA were determined in freshly isolated gingival tissue by real time reverse transcription-polymerase chain reaction (real time RT-PCR) in 30 gingival specimens.

RESULTSIn 18 gingival specimens, hBD-4 peptides were expressed in 13 gingival specimens. In 30 gingival specimens, hBD-4 were detected in 4 gingival specimens by real time RT-PCR.

CONCLUSIONThe distribution and the expression levels of hBD-4 are different in healthy gingiva. This result may suggest that the hBD-4 play a role in maintaining the periodontal health.

Gingiva ; Humans ; RNA, Messenger ; beta-Defensins

OBJECTIVETo explore the quantitative relationship between the intensity of psychosocial stress and the degree of overall health damages.

METHODSA multi-group case-control study was designed and implemented. The cases included two groups of out-patients (177) and in-patients (214) in a hospital in Jianyang city, and controls (587) were from the follow-up cohort in the same city. Three groups were studied on the following contents: general demographic characteristics, psychosocial factors and the degree of health damages including mental, physical, and social status. Major statistical analyses were as follows: ranks test, ANOVA, cluster analysis, multinomial logistic regression and ordered-logit regression.

RESULTSOrdered-logit regression model showed that the odds ratio of negative life-events on degree of health damages was 1.335 (P < 0.01). This result showed that there was a positive dose-effect relationship between the negative life-events score and overall health damages. The utility of social support to overall health had protective effect (OR = 0.513).

CONCLUSIONNegative life-events were the major risk factors to overall health, and there was a dose-effect relationship between negative events and health damages. Function of social support played a protective factor for health.

Analysis of Variance ; Case-Control Studies ; Cohort Studies ; Educational Status ; Health Status ; Humans ; Marital Status ; Social Class ; Stress, Psychological ; psychology

Objective:To explore the application value of optical surface monitoring system (OSMS) volume rendering technique (VRT) body surface imaging in intensity-modulated radiotherapy for thoracic tumors.Methods:A retrospective case series study was performed. The clinical data of 65 patients with thoracic tumors treated with intensity-modulated radiotherapy at Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from September 2021 to October 2022 were retrospectively analyzed. In the first treatment,after cone-beam computed tomography (CBCT) scan and correction, VRT body surface images were obtained by using OSMS. In subsequent treatment, the VRT image was used as the benchmark and the 6-dimensional bed was automatically positioned to record the 6-dimensional bed positioning value. The CBCT scan was performed to record the translation and rotation errors of left-right direction (X-axis), head-foot direction (Y-axis) and front-rear direction (Z-axis). After the calibration of the 6-dimensional automatic bed shifting, the new real-time deltas (RTD) value of digital imaging and communications in medicine (DICOM) body surface image was recorded, and the new VRT image was obtained. CBCT registration error value was defined as VRT image-guided setup error. The sum of CBCT registration error value and moving bed movement value was defined as the body surface marker line-guided setup error. The sum of CBCT registration error value and the recorded DICOM image RTD value was defined as the theoretical error of DICOM image-guided setup. The advantages and disadvantages of VRT image, body surface marker line and DICOM image-guided setup were compared and analyzed.Results:There were 42 males and 23 females in 65 patients with thoracic tumors, and the age [ M ( Q1, Q3)] was 58 years (51 years, 64 years). The linear errors [ M ( Q1, Q3)] of VRT image-guided setup in X, Y and Z axes were 0.6 mm (0.3 mm, 1.2 mm), 1.2 mm (0.5 mm, 2.4 mm) and 1.1 mm (0.5 mm, 1.9 mm); and the rotational errors were 0.4° (0.1°, 0.7°), 0.4° (0.1°, 0.6°) and 0.4° (0.2°, 0.6°). The linear errors of the marker line-guided setup were 1.6 mm (0.9 mm, 2.6 mm), 2.2 mm (1.1 mm, 3.8 mm) and 1.0 mm (0.4 mm, 1.8 mm); and the rotational errors were 0.7° (0.3°, 1.2°), 0.5° (0.2°, 0.8°) and 0.5° (0.2°, 0.8°). The linear errors of the DICOM image-guided positioning were 1.1 mm (0.6 mm, 1.9 mm), 2.1 mm (1.0 mm, 3.4 mm) and 1.3 mm (0.6 mm, 3.1 mm), and the rotational errors were 0.6° (0.2°, 1.1°), 0.7° (0.3°, 1.1°), 0.7° (0.2°, 1.1°). Compared with the marker line-guided setup, except for Z-axis linear error ( P = 0.218), the VRT-guided setup errors were low (all P < 0.001). Compared with the DICOM imaging-guided setup, the VRT image-guided setup linear error and rotational error in X-, Y- and Z-axis were low (all P < 0.01). Conclusions:VRT image-guided setup is superior to traditional body surface marker setup and DICOM imaging setup; OSMS VRT body surface imaging can effectively improve the setup accuracy and stability of intensity-modulated radiotherapy for thoracic tumors, and reduce the setup errors.

Objective To approach the predictive value of continuous monitoring end-tidal carbon dioxide partial pressure (PETCO2) on the outcome of in-hospital cardiopulmonary resuscitation (CPR), and explored the indicators of termination of resuscitation. Methods A secondary analysis of a multicenter observational study data was conducted. The screening aim was adult non-traumatic in-hospital CPR patients whose PETCO2were recorded within 30 minutes of CPR. Clinical information was reviewed. The mean PETCO2in restoration of spontaneous circulation (ROSC) and non-ROSC patients was recorded. The outcome of CPR was continuously assessed by PETCO2≤ 10 mmHg (1 mmHg = 0.133 kPa) for 1, 3, 5, 8, 10 minutes. Receiver operating characteristic (ROC) curve was plotted, and the predictive value of PETCO2≤ 10 mmHg for different duration on the outcome of CPR was evaluated. Results A total of 467 recovery patients, including 419 patients with complete recovery were screened. Patients who were out-of-hospital resuscitation, non-adults, traumatic injury, had no PETCO2value, PETCO2value failed to explained the clinical conditions, or patients had not monitored PETCO2within 30 minutes of resuscitation were excluded, and finally 120 adult patients with non-traumatic in-hospital resuscitation were enrolled in the analysis. The mean PETCO2in 50 patients with ROSC was significantly higher than that of 70 non-ROSC patients [mmHg: 17 (11, 27) vs. 9 (6, 16), P < 0.01]. ROC curve analysis showed that the area under ROC curve (AUC) of PETCO2during the resuscitation for predicting recovery outcome was 0.712 [95% confidence interval (95%CI) = 0.689-0.735]; when the cut-off was 10.5 mmHg, the sensitivity was 57.8%, and the specificity was 78.0%, the positive predictive value (PPV) was 84.6%, and negative predictive value (NPV) was 46.9%. The duration of PETCO2≤ 10 mmHg was used for further analysis, which showed that with PETCO2≤10 mmHg in duration, the prediction of the sensitivity of the patients failed to recover decreased from 58.2% to 28.2%, but specificity increased from 39.4% to 100%; PPV increased from 40% to 100%, and NPV decreased from 57.5% to 34.2%. Conclusion For adult non-traumatic in-hospital CPR patients, continuous 10 minutes PETCO2≤10 mmHg may be an indicate of termination of CPR.

Objective:To explore the clinical application value of Bodyfix fixation device in stereotactic body radiotherapy (SBRT) for elderly patients with lung cancer.Methods:The clinical data of 63 elderly patients with lung cancer who received SBRT in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January to October 2021 were retrospectively analyzed. According to different fixation methods, the patients were divided into Bodyfix combined with vacuum bag fixation device group (Bodyfix group, 20 cases) and 4D respiratory gating technology combined with vacuum bag fixation device group (vacuum bag group, 43 cases). Cone beam CT (CBCT) was used for position verification before each treatment, linear and rotational errors in the horizontal (X), head-to-foot (Y), front-to-back (Z) directions were recorded.Results:The linear errors of Bodyfix group in the X, Y and Z directions were 1.7 mm (1.3 mm, 3.0 mm), 4.6 mm (4.3 mm, 5.3 mm) and 1.3 mm (0.8 mm, 2.8 mm), and the rotational errors were (0.46±0.04)°, (-0.48±0.05)° and 0.64°(0.38°, 1.07°); the linear errors of vacuum bag group in the X, Y and Z directions were 2.1 mm (1.6 mm, 3.3 mm), 2.8 mm (1.8 mm, 3.7 mm) and 3.0 mm (2.3 mm, 3.8 mm), and the rotational errors were (0.69±0.04)°, (-0.70±0.04)° and 0.64° (0.42°, 0.86°). The differences in linear errors in the Y and Z directions and rotational errors in the X and Y directions between the two groups were statistically significant ( P values were <0.001, <0.001, 0.003 and 0.007). Conclusions:Compared with the 4D respiratory gating technology, the Bodyfix fixation device has smaller rotational errors in the X and Y directions and linear errors in the Z direction. It can be used as an effective method of postural fixation for SBRT in elderly patients with lung cancer.

Objectives To study the effect of cadmium (Cd) on the proliferation and apoptosis of mouse spermatocyte (GC-2 spd) cells and explore the underlying molecular mechanism. Methods GC-2 spd cells were cultured with 0, 5, 10, 15, 20 and 30 μM CdCl2, respectively, for 24 hours. The cell viability and IC50 of Cd were estimated based on CCK-8 data. The apoptosis of GC-2 spd cells and cellular concentration of ROS were analyzed by flow cytometry after treatment of the cells with different concentrations of CdCl2 (0, 5, 10 μM) for 24 hours. The expression levels of JNK/c-Jun signaling pathway regulatory proteins, pro-apoptotic factor Bax and anti-apoptotic factor Bcl-2, were determined by Western blot. Results Cd inhibited the proliferation of GC-2 spd cells with IC50 value of 12.99 μM, 95% CI [11.95, 14.00]. Exposure to 5 and 10 μM CaCl2 resulted in increases in apoptosis and cellular ROS generation in a dose-dependent manner, which was statistically significant compared with the control (P < 0.05). Although there was no difference in the expression level of c-Jun (P > 0.05), the phosphorylation level of JNK and c-Jun in Cd group was highly increased as compared to the control (P < 0.05). In addition, Cd exposure significantly increased the expression of Bax protein but decreased the expression Bcl-2 protein (P < 0.05). Conclusions Cadmium induces GC-2 spd cell apoptosis by increasing concentration of ROS and regulating the JNK/c-Jun signaling pathway.