Purpose To estimate and discuss the feasibility of the threshold value of the internal tumor volume (ITV) of lung cancer based on the standardized uptake value (SUV) of the background.Materials and Methods The phantom was designed with 3 vacuous models fixed at the bottom of a barrel. The 3 vacuous models were filled with18F-FDG (55.0 kBq/ml) which represented a tumor and the barrel was filled with18F-FDG (5.9 kBq/ml), which represented the background of the lung. The barrel moved sinusoidally with distances of 10.9 mm, 21.8 mm, and 43.7 mm to simulate breathing, and then the phantom 2D PET/CT data were acquired. The SUV in the background was recorded as ±SD, and+3SD was regarded as threshold value to obtain the measured ITVs. The Dice similarity coefficient (DSC) and volume recovery coefficient (VRC) were used to evaluate the accuracy of the ITVs measured by seven methods, including that by SUV 2.5, 35% SUVmax, 41% SUVmax, a×mSUV70+b×, 0.42×(SUVmax+) and Riegel et al. computed threshold value followed the gross tumor volume, tumor-to-nontumor ratio and motion extent.Results Nine ITVs of three lung cancer models were 134.3 ml, 166.1 ml, 223.5 ml, 86.6 ml, 108.5 ml, 150.7 ml, 32.3 ml, 43.8 ml and 63.6 ml, respectively. The ITV measured by Riegel et al. showed no difference with the real ITV (t=-0.48,P>0.05). The ITVs measured by the other six methods were significantly different from the real ITVs (t=-5.11-2.76,P<0.05). The DSC of the ITV measured by+3SD and the method of Riegel et al. were 0.75-0.92 and 0.69-0.93, respectively; and the VRC were 0.82-0.97 and 0.74-0.96, respectively (differences without significance:t=-0.73,P>0.05). Moreover, they surpassed the results of the other five methods.Conclusion The threshold value (+3SD) of the SUV determined by the background has potential value in the description of the ITV of lung cancer, so as to provide reference for radiotherapy.

Primary dysmenorrhea (PDM), cyclic menstrual pain in the absence of pelvic anomalies, is characterized by acute and chronic gynecological pain disorders in childbearing age women. PDM strongly affects the quality of life of patients and leads to economic losses. PDM generally do not receive radical treatment and often develop into other chronic pain disorders later in life. The clinical treatment status of PDM, the epidemiology of PDM and chronic pain comorbidities, and the abnormal physiological and psychological characteristics of patients with PDM suggest that PDM not only is related to the inflammation around the uterus, but also may be related to the abnormal pain processing and regulation function of patients' central system. Therefore, exploring the brain neural mechanism of PDM is indispensable and important to understand the pathological mechanism of PDM, and is also a hotspot of brain science research in recent years, which will bring new inspiration to explore the target of PDM intervention. Based on the progress of the neural mechanism of PDM, this paper systematically summarizes the evidence from neuroimaging and animal model studies.
Animals ; Humans ; Female ; Dysmenorrhea ; Brain Mapping ; Chronic Pain ; Quality of Life ; Neuroimaging ; Models, Animal

OBJECTIVETo describe the clinical manifestations and lung imaging characteristics of the human transmissible highly pathogenic H5N1 avian influenza.

METHODSThe clinical manifestations and lung imaging characteristics of human transmissible highly pathogenic H5N1 avian influenza in one patient were reviewed and analyzed.

RESULTSThe patient had the clear history of occupational exposure. The fever and symptoms of influenza were prominent at onset and associated with the symptoms of the digestive tract. The laboratory findings comprised the significant decrease of the white blood cell count and the lymphocyte number and the impairment of the liver function and the myocardial enzymes. The disease progressed rapidly and multiple organs including lung, heart, liver and kidneys were involved. It was ineffective to administer anti-fungal, anti-virus and anti-inflammation medicines. It was in vain to use mechanical ventilation and pneumothorax intubation and closed drainage as well as the support therapy. In the X-ray film, the lesions progressed quickly and changed diversely with absorption and development at the same time. The nasal and throat swabs and the gargle specimen were detected with RT-PCR and real time PCR by Chinese Center for Disease Control and Prevention. The results showed that both the specific HA and NA genes of the avian influenza virus H5N1 subtype were positive and in the same time a strain of avian influenza virus A/jiangxi/1/2005H5N1) was separated and obtained from the nasal and throat swabs. The autopsy showed that diffuse injury of alveolus in lungs, DIC and multiple organ injury.

CONCLUSIONThe human transmissible highly pathogenic H5N1 avian influenza is a lethal disease. The disease progresses rapidly with the absorption and development at the same time in the lungs and unfortunately there are no effective therapeutic measures. The prevention of the contagious disease for the occupationally exposed population should be emphasized.

Adult ; Humans ; Influenza A Virus, H5N1 Subtype ; Influenza, Human ; diagnosis ; etiology ; therapy ; Male ; Occupational Exposure ; adverse effects

Objective To compare the dosimetric differences of four fluence smoothing (FS) levels of the Monaco system in intensity-modulated radiation therapy (IMRT) after rectal cancer surgery, and to provide a reference for FS selection in clinical practice. Methods A total of 15 postoperative patients with rectal cancer admitted in 2020 were selected. Under the same optimal conditions, FS was set to Off, Low, Medium, and High for IMRT planning. The data were analyzed by SPSS 20.0 software. The dosimetric parameters of planning target volume and organs at risk (OARs), the number of Segments, the number of monitor units (MUs), the estimated total delivery time (ETDT), and the gamma pass rate were compared between the four FS levels. Results The four FS levels resulted in clinically acceptable dosimetric parameters of the planning target volume and OARs, and there was no significant difference in dose distribution between FS levels. From FS-Off to FS-High, number of Segments, number of Mus, and ETDT decreased by 15.2%, 11.8%, and 6.7%, respectively, whereas gamma pass rate increased by 1.6%. Conclusion The IMRT plans at four FS levels can meet the clinical requirements. Considering the planning quality and execution efficiency, FS-High is recommended for postoperative IMRT of patients with rectal cancer.

OBJECTIVETo study the effect of diallyl thiosulfinate (DATS) on the proliferation of side population (SP) cells in multiple myeloma (MM) and its mechanism.

METHODSRPMI-8226 and NCI-H929 cells were cultured, and the level of SP cells was detected by Hoechst33342 staining. The SP cells were cultured and treated with 10 µg/ml DATS, the CCK8 assay was carried out to examine the effect of DATS on the proliferation ability in SP cells, and plate colony-forming test was used to examine the colony-forming ability, the flow cytometry assay was carried out to examine the cell cycle, Western blot assay was used to examine the expression of cyclin D1, cyclin E, CDK2 and CDK4.

RESULTSSP cells were detected in RPMI-8226 and NCI-H929 cells with a proportion of 3.17±0.98 and 2.65±0.61, respectively. DATS treatment could significantly inhibit the SP cells survival in a time-dependent manner, and also could significantly inhibit the colony forming. In addition, DATS treatment could significantly induce the G/S arrest and suppress the expression of cyclin D1, cyclin E, CDK2 and CDK4.

CONCLUSIONDATS can inhibit the proliferation and colony-forming of SP cells in multiple myeloma, and induce the G/S arrest that may be carried out via suppressing the expression of cyclin D1, cyclin E, CDK2 and CDK4.

Rheumatoid arthritis of the knee is a common disease, but suppurative arthritis caused by Gemella morbillorum in the same joint is rare. We report a case of suppurative arthritis caused by Gemella morbillorum in a patient with rheumatoid arthritis. Because the infection symptoms was not typical, the diagnosis was delayed, and the delayed diagnosis and therapy led to a poor outcome of the patient.
Arthritis, Infectious ; complications ; Arthritis, Rheumatoid ; complications ; Female ; Gemella ; isolation & purification ; Gram-Positive Bacterial Infections ; complications ; Humans ; Knee Joint ; Middle Aged

Objective To explore the influence of dexmedetomidine combined with sufentanil on postoperative analgesia effect and immune function for patients undergoing lower limb fracture surgery. Methods One hundred cases patients of lower limb fracture undergoing open reduction and internal fixation of elective surgery in our hospital from January 2016 to November 2016 were selected ( ASAⅠ-Ⅱgrade, male 51 cases and female 49 cases, 30-65 years old, 50-75 kg). All cases were randomly divided into sufentanil group (Group S) and dexmedetomidine combined with sufentanil group (Group DS) according to the random number table, who used patient-controlled intravenous analgesia (PCIA). The PCIA drug formulations of two groups were as followings: sufentanil group (Group S) used 3 μg/h sufentanil+ondansetron 16 mg, dissolved in 0.9%sodium chloride injection 100 ml;dexmedetomidine combined with sufentanil group (Group DS) used dexmedetomidine 0.1μg/(kg · h)+sufentanil 2μg/h+ondansetron 16 mg, dissolved in 0.9%sodium chloride injection 100 ml;background infusion rate was 2 ml/h, and loading dose was 2 ml. Dose for patient-controlled analgesia (PCA) was 0.5 ml, and locking time was 15 min. The changes of pain, MAP, HR , sedation scores were recorded at 4 h (T1), 8 h (T2), 24 h (T3) and 48 h (T4) after operation; nausea and vomiting, hypotension, bradycardia, respiratory depression and other adverse reactions were aslo recorded at the same time. At 10 min before induction of anesthesia (T0) and T1-T4 after operation, the CD3+, CD4+, CD8+and NK cell activity of peripheral blood T lymphocyte subsets were determined using flow cytometry, and CD4 +/CD8 + ratio was calculated. Results The levels of MAP and HR in DS group at each time point after operation were lower than those in group S (P<0.05), the level of visual analogue score (VAS) in DS group at different time points were significantly lower than those of s group: (1.8 ± 0.3) scores vs. (2.5 ± 0.5) scores, (1.1 ± 0.5) scores vs. (1.9 ± 0.3) scores, (1.0 ± 0.5) scores vs. (1.8 ± 0.5) scores, (0.8 ± 0.3) scores vs. (1.5 ± 0.6) scores (P < 0.05), Ramsay Sedation score was significantly higher than that of s group: (3.5 ± 0.3) scores vs. (2.4 ± 0.6) scores, (3.3 ± 0.5) scores vs. (2.5 ± 0.3) scores, (3.5 ± 0.6) scores vs. (2.3 ± 0.5) scores, (3.2 ± 0.4) scores vs. (2.2 ± 0.5)scores (P<0.05);nausea and vomiting occurred in two patients after the operation of group DS , which was significantly lower than that of S group (P<0.05);compared with those at T0, CD3+, CD4+, CD4+/CD8+and NK cells in the two groups of patients decreased significantly at the time of T1-T4 (P<0.05);The levels of CD3+, CD4+, CD4+/CD8+and NK cells were significantly higher in group DS at T1- T4 than those in group S(P < 0.05). Conclusions Dexmedetomidine combined with sufentanil for analgesia in patients with lower limb fracture surgery has better effect. It decreases the incidence of nausea and vomiting, and improves the cellular immune function of patients.

Objective To evaluate the efficacy and safety of intense pulsed light (IPL) combined with hydroquinone cream for melasma treatment.Methods Thirty-five patients with melasma were treated between February 2015 and February 2017,20 patients treated with IPL combined with hydroquinone cream and 15 patients with IPL alone.All cases were female patients with Fitzpatrick skin types Ⅲ and Ⅳ,and subjected to 4 weeks treatment 1 time,5 times for a course of treatment.All patients were followed up for six months and the efficacy and safety of the treatment were analyzed comprehensively by subjective satisfaction and physician evaluation.Results All the patients were treated without discomfort and treated patients were effectively followed up.The satisfactory rate of IPL treatment group was 73.3％,and that of combined with hydroquinone cream group was 100％.Two groups of satisfactory rates were higher in IPL combined with hydroquinone cream.The total effective rate of the IPL treatment group was 53.3％ compared with that of the 35 patients before and after treatment;in IPL combined with hydroquinone cream treatment group the total effective rate was 85.0％.IPL combined with hydroquinone cream treatment group was significantly more effective than the treatment group (P＜0.05).All treatment patients did not present with tissue damage,pigmentation and other adverse reactions.Conclusions IPL combined with hydroquinone cream is a safe and effective treatment of melasma,and patients get a higher rate of satisfaction.

Objective To find the effects of varus degree on the early metabolic changes of the lateral compartment cartilage in knees with medial unicompartmental osteoarthritis by detecting glycosaminoglycan (GAG) in varus knees.Methods From June 2016 to December 2017,twenty middle-aged volunteers without osteoarthritis or coronal deformities were recruited as the control group.Sixty patients diagnosed as medial unicompartmental osteoarthritis were recruited as the osteoarthritis group.The patients were further divided into four groups according to the degrees of varus angle,namely 2°-5° varus group,5°-10° varus group,10°-15° varus group and ＞15° varus group with 15 patients in each group.Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) was performed in all participants.The dGEMRIC indices (T1Gd) representing GAG content were calculated in the weight-bearing femoral cartilage (wbFC),the posterior non-weight-bearing femoral cartilage (pFC),the lateral femoral cartilage (FC,wbFC+pFC) and the tibial cartilage (TC) in the lateral compartment by using Matlab 7.1 and MRIMapper software.Results T1Gd of wbFC,pFC,FC and TC were 400.3±51.5 ms,393.6±57.9 ms,397.5±52.3 ms and 448.6±62.5 ms in the control group,391.8±41.5 ms,407.2±43.8 ms,400.1±37.8 ms and 461.3±41.6 ms in 2°-5° varus group and 386.9±57.1 ms,401.3±73.5 ms,397.7±59.6 ms and 438.9±42.8 ms in 5°-10° varus group.There was no significant difference among the above three groups in T1Gd in any of the analyzed cartilage regions (P＞0.05).In 10°-15° varus group,T1Gd of wbFC,pFC,FC and TC were 380.1±45.5 ms,385.5±76.6 ms,384.0±53.5 ms and 400.2±43.8 ms,respectively.Although T1Gd of wbFC,pFC and FC in 10°-15° varus group were similar with that in the control group,2°-5° varus group and 5°-10° varus (P＞0.05),T1Gd of TC in 10°-15° varus group decreased significantly (P＜0.05).In addition,T1Gd of wbFC,pFC,FC and TC in ＞15° varus groupwere 327.7±54.3 ms,340.1±33.0 ms,334.9±36.0 ms and 363.6±48.6 ms,respectively.T1Gd of all regions of interest in ＞15° varus group were significantly lower than that informer four groups (P＜0.05).Conclusion In medial unicompartmental knee osteoarthritis,there is a relationship between varus degree and GAG content of the lateral compartment cartilage.If varus angle ≤10°,the GAG content of the lateral compartment cartilage was similar with the similar aged subjects without osteoarthritis.If varus angle ＞ 10°,GAG content of the lateral compartment decreases significantly.

Objective To evaluate the role of cholinergic anti-inflammatory pathway in dexmedeto-midine pretreatment-induced reduction of acute lung injury in a rat model of intestinal ischemia-reperfusion ( I∕R) . Methods Twenty-four healthy male Sprague-Dawley rats, aged 2-3 months, weighing 200-250 g, were divided into 4 groups ( n=6) using a random number table method: sham operation group ( S group) , intestinal I∕R group ( II∕R group ) , dexmetomidine group ( DEX group) and α7 nicotinic acetyl-choline receptor antagonistα-bungarotoxin (α-BGT) group (α-BGT group) . Intestinal I∕R was produced by occlusion of the superior mesenteric artery ( SMA) for 60 min followed by 120 min of reperfusion in anesthe-tized rats. Dexmetomidine 5 μg·kg-1 ·h-1 was injected via the tail vein at 1 h before operation in DEX group andα-BGT group. α-BGT 1μg∕kg was intraperitoneally injected at 15 min before dexmetomidine in-jection in α-BGT group. Rats were sacrificed at 120 min of reperfusion, and lung tissues were obtained for microscopic examination of pathological changes ( with a light microscope) and for determination of wet∕dry weight ratio ( W∕D ratio) , tumor necrosis factor-alpha ( TNF-α) and interleukin-6 ( IL-6) contents ( using enzyme-linked immunosorbent assay) , malondialdehyde ( MDA) content ( using thiobarbital acid method) and superoxide dismutase ( SOD) activity ( by xanthine oxidase method) . Results Compared with group S, the W∕D ratio and contents of MDA, TNF-αand IL-6 were significantly increased, and the SOD activi-ty was decreased in II∕R and α-BGT groups, and TNF-α and IL-6 contents were significantly increased in group DEX ( P<0. 05) . Compared with group II∕R, the W∕D ratio and contents of MDA, TNF-αand IL-6 were significantly decreased, SOD activity was increased (P<0. 05), and the pathological changes were significantly attenuated in group DEX. Compared with group DEX, the W∕D ratio and contents of MDA, TNF-α and IL-6 were significantly increased, SOD activity was decreased ( P<0. 05) , and the pathological changes were accentuated in group α-BGT. Conclusion Activation of cholinergic anti-inflammatory path-way is involved in the mechanism by which dexmedetomidine pretreatment reduces acute lung injury in a rat model of intestinal I∕R.