Objective:To investigate the effectiveness of abdominal compression in tumor motion and the target volume, and analyze the suitable margins of planning target volume (PTV) for patients treated with lung-SBRT based on 4DCT.Methods:Patients diagnosed with peripheral pulmonary tumor were enrolled. The patients were divided into the whole group, upper-middle-lobe group (group A) and the lower-lobe group (group B). Each patient underwent 3DCT, 4DCT with abdominal compression (4DCT com) and 4DCT with free breath (4DCT free) scans. The GTVs were delineated and IGTVs on these images. PTV MIP 5 mm, PTV MIP 4 mm, PTV MIP 3 mm were constructed with a 5, 4, 3 mm margin in left-right (LR), anterior-posterior (AP) directions and cranial-caudal (CC) directions. Results:The median motion vector with compression reduced by 30.92% in whole group, increased by 3.42% in group A and reduced by 18.80% in group B, respectively. And there were no significant differences of TMA LR, TMA AP, TMA CC and motion vector by the Wilcoxon test ( P>0.05). The median sizes of IGTV MIP com , IGTV MIP free and IGTV10 com, IGTV10 free were 4.01, 5.36 cm 3and 6.59, 7.65 cm 3, with statistically significant difference ( Z=-3.45, -3.14, P<0.01). The median ratio of DI of IGTV CBCT com in PTV MIP 5 mm, PTV MIP 4 mm and PTV MIP 3 mm≥95% was 100%, 100% and 83.33%, respectively. Conclusions:The patients′ respiratory pattern changed with abdominal compression and abdominal compression is useful in reducing the size of IGTV MIP and IGTV10, which could reduce the target volume and protect the normal tissue. Adding a 4 mm margin to IGTV MIP com based on 4DCT account for respiration in SBRT is a tendency for precise radiotherapy.

Objective : To learn the passive smoking exposure and hazard awareness among the residents aged 18 years and over in Zhengzhou,so as to provide evidence for tobacco control. Methods: By multi-stage stratified and clustered sampling method,the residents aged 18 years and over in Zhengzhou were selected. From June to October in 2018,a questionnaire for risk factors of non-communicable diseases,designed by Chinese Center for Disease Control and Prevention,was used to collect their passive smoking exposure and hazard awareness and then analyzed. Results : A total of 6 793 questionnaires were qualified in 6 809 questionnaires and the effective rate was 99.77%. Among 5 387 non-smokers,2 131 people were exposed to passive smoking,and the crude and standardized rate was 39.56% and 40.14%. The standardized rate of passive smoking exposure was higher in men than in women（42.44% vs. 38.67%,P<0.05）,in rural residents than in urban residents（43.90% vs. 36.62%,P<0.05）,and it decreased with the age increase（P<0.05）. The standardized rate of passive smoking exposure in family,indoor workplace and indoor public place was 30.99%,36.99% and 68.02%,respectively. The standardized awareness rate of “passive smoking exposure may lead to heart disease,lung disease in children and lung cancer in adults” was 56.63%,which was higher in urban rural residents than in rural residents（75.69% vs. 36.33%,P<0.05）. Conclusions The passive smoking exposure rate was high in Zhengzhou,especially in indoor public places. The awareness of the hazards of passive smoking exposure was scarce, especially in rural residents.

Objective This study aims to analyze the prevalence, distribution, and risk factors of abnormal glucose metabolism in urban and rural adult hypertension patients in Zhengzhou. Methods The study was conducted on permanent residents aged 18 years and over (with at least 6 months of residence) in urban and rural areas of Zhengzhou. The survey subjects were chosen by the multi‐stage sampling method. Basic information regarding the height, weight, waist circumference, and blood pressure of 6 798 people who met the standards of admission and discharge were obtained through an on‐site questionnaire survey and physical examination. Blood samples were collected and blood glucose and lipid levels were detected. Results There were 1 985 patients with hypertension, with a prevalence rate of 29.20% and the standardized prevalence rate was 26.53%. Blood samples were collected from 1 936 hypertensive patients (55.8±13.6 years), of whom 903 were male (46.64%) and 1 033 female (53.36%). Among 1 050 patients (54.24%) with abnormal glucose metabolism, the impaired fasting glucose rate was 4.44%, the decreased glucose tolerance rate was 22.21%, and the diabetes rate was 27.56%. Blood samples were collected from 4 748 non‐hypertensive patients and 1 123 patients (23.65%) with abnormal glucose metabolism. The prevalence of abnormal glucose metabolism in hypertensive patients was significantly higher than that in non‐hypertensive patients, and the difference was statistically significant (χ2=586.264, P<0.001). The prevalence rate of abnormal glucose metabolism in hypertensive patients was higher in females, 58.57%, than in males, 49.28% (χ2=16.743, P<0.001). Urban patients showed a higher abnormal glucose metabolism, 57.68%, than rural patients did, 51.67% (χ2=6.984, P<0.001), and the prevalence of abnormal glucose metabolism in hypertensive patients showed a significant upward trend with an increase in age. Patients with central obesity, abnormal blood lipids, family diabetes history, non‐smokers, and non‐drinkers showed a higher prevalence of abnormal glucose metabolism, and the differences were statistically significant (P<0.05). The prevalence of abnormal glucose metabolism increased with age and body mass index, and decreased with increase in education level, with differences being statistically significant (P<0.001). Multivariate logistic regression analysis showed that age, obesity, centripetal obesity, dyslipidemia, and family history of diabetes were the main risk factors for abnormal glucose metabolism in patients with hypertension. Conclusions There is a relatively high prevalence of abnormal glucose metabolism in hypertension patients among the urban and rural residents of Zhengzhou. In the management of hypertension, the detection and intervention for reducing abnormal glucose metabolism should be strengthened and related risk factors must be prevented. The age for health management objectives among hypertension and diabetes patients should be further reduced.

Objective    To investigate the results of emergent aortic arch replacement using moderate hypothermic circulatory arrest and unilateral antegrade cerebral perfusion (MHCA+UACP). Methods    We retrospectively analyzed the clinical data of 146 patients who underwent emergent aortic arch replacement using MHCA+UACP in our institution from January 2008 to June 2018. There were 111 males and 35 females aged 60.3±7.2 years. According to different surgical approaches, patients were divided into two groups: a total arch replacement (TAR) group (n=104) and a semi arch replacement (SAR) group (n=42). Right axillary artery was cannulated for cardiopulmonary bypass (CPB) and cerebral perfusion. Core temperature at the onset of MHCA was 23.4±1.4 ℃. UACP was initiated at 18-22 ℃ with the flow of 5-10 ml/(kg·min). Flow was adjusted to maintain cerebral perfusion pressure of 50–60 mm Hg. Results    CPB time was 235.0±42.0 min. Aortic clamp time was 154.0±29.0 min. Circulatory arrest (CA) time was 48.1±13.0 min. The CPB time and CA time of the TAR group were longer than those of SAR group. Overall mortality rate was 9.6%. Complications included permanent neurological dysfunction (PND), temporary neurological dysfunction (TND), acute kidney injury (AKI) requiring dialysis and delayed extubation (mechanical ventilation time > 72 hours). Overall incidence of PND and TND was 2.7% and 6.8%, respectively. The incidence of AKI requiring dialysis was 4.1%. The incidence of delayed extubation was 21.9%. No difference of mortality rate or incidence of complications was found between the two groups. The average follow-up was 63.0±33.1 months. The 5-year survival rate was 72.6% in the TAR group and 85.5% in the SAR group. Conclusion    Emergent aortic arch replacement using MHCA+UACP can be accomplished with excellent results.

Objective To explore the relationship between syncope and risk of death in patients with cardiovascular emergencies including acute myocardial infarction(AMI), arrhythmia, acute heart failure(AHF), pulmonary thromboembolism(PTE) and aortic dissection(AD) rupture. Methods Data from 2 789 patients with cardiovascular emergency admitted from June 2010 to June 2016 in the Emergency Department, Air Force General Hospital, PLA was retrospectively analyzed. Difference in gender, age and motality were compared between patients with syncope and those without syncope. Among fi ve kinds of cardiovascular emergency events with syncope, difference in mortality were compared. Difference in mortality were also analyzed by the CHM corrected chi square test when difference of disease, gender and age were taken into consideration. Syncope, the type of cardiovascular emergency, gender and age were analyzed as potential risk/protective factors for death by the multiple logistic regression analysis. Results The mortalities of the fi ve diseases accompanied with syncope were 50%, 30.43%, 26.53%, 20% and 7.04% respectively in arterial dissection, pulmonary embolism, acute myocardial infarction, acute heart failure and arrhythmia.There was a statistically signifi cant difference in mortality among the fi ve kinds of cardiovascular emergencies accompanied with syncope(P<0.05).The mortalities of patients with syncope were significantly higher than those without syncopein AMI patients(26.53% vs.11.20%,P<0.05) and cardiac arrhythmias patients(7.04% vs.0.36%,P<0.05).The results of the CHM corrected chi square test showed that there was signifi cant difference in mortality between the syncope group and non-syncope group, when the differences in disease type, age and gender were adjusted (χ2=35.876, P<0.01). The mortality of syncope group was higher than that of non-syncope group.When age, gender and disease type were considered as covariates, the multiple logistic regression analysis showed that syncope signifi cantly increased the risk of mortality(OR=3.876,95% CI:2.362-6.359,P<0.01).Conclusion Syncope is an independent risk factor of death in patients with cardiovascular emergencies.

Objective To investigate the risk factors of death in patients with syncope. Methods Clinical data of 516 patients experienced syncope admitted from June 2010 to June 2016 were analyzed retrospectively. Factors including gender, age, history of hypertension, diabetes mellitus, hyperlipidemia, smoking history, drinking history, and etiology of syncope (cardiogenic syncope, neuroreflex syncope, orthostatic hypotension, orthostatic syncope, unexplained syncope, and syncope caused by other special diseases) were analyzed as likely risk factors of death within 30 days after syncope happened. After adding the derived variables (over 22 new factors), analyses were done to investigate independent risk factors of death for patients with syncope. Results This study included 321 male (62.2％) and 195 females (37.8％), with mean age of (62.23±19.69) years. Logistic regression analyses showed that age (OR=1.033, 95％ confidence interval (95％CI):1.008-1.058, P =0.008 8),cardiac syncope (OR=19.704,95％CI:5.894-5.875,P＜0.01) were independent risk factors of death within 30 days after syncope occurred. Multiple-variate analysis with derived variables showed that cardiac syncope (OR=11.487, 95％CI:4.938-26.721,P＜0.01),age and age derived variables (OR=1.000, 95％CI:1.000-1.000,P=0.000 8),age and cardiogenic syncope derivative variables (OR=1.033, 95％CI:1.022-1.044, P＜0.01) were independent risk factors for death within 30 days after syncope. Conclusion Age and cardiogenic syncope were independent risk factors for death within 30 days after syncope occurred. And a derivative factor of age, and interactivity between age and cardiac syncope were independent risk factors of death in patients with syncope.

AIM: To explore the effect of pyrrolidine dithiocarbamate (PDTC), an NF-κB inhibitor, on the proliferation and apoptosis of human multiple myeloma U266 cells and its mechanisms.METHODS: The U266 cells were treated with PDTC at different concentrations (0, 25, 50, 100 and 200 μmol/L) in vitro.The growth inhibitory rate of the U266 cells was detected by CCK-8 assay and cell counting.The cell cycle of the U266 cells was determined by flow cyto-metry, and the apoptosis was examined by flow cytometry with Annexin V-FITC/PI staining.The effect of PDTC on the expression of DNA methyltransferase 1 (DNMT1) at mRNA and protein levels was measured by RT-qPCR and Western blot, respectively.The effects of PDTC on the protein levels of NF-κB (P65), DNMT1, Bcl-2, cyclin D1, cleaved caspase-3 and cleaved caspase-8 were determined by Western blot.RESULTS: The protein level of NF-κB (P65) was decreased after treatment with PDTC for 48 h or 72 h.PDTC inhibited the proliferation of U266 cells in both dose-and time-dependent manners.After treatment with PDTC for 48 h, the percentage of U266 cells in G2 phase increased compared with control group (P<0.05).PDTC induced the apoptosis of U266 cells in a dose-dependent manner.The expression of DNMT1 at mRNA and protein levels decreased (P<0.05).The results of Western blot showed that the expression of Bcl-2 in PDTC groups decreased, while the protein levels of cyclin D1, cleaved caspase-3 and cleaved caspase-8 were higher than those in control group (P<0.05).CONCLUSION: The NF-κB inhibitor PDTC inhibits the proliferation of U266 cells by inducing cell apoptosis.It may be related to the down-regulated expression of DNMT1, cell cycle arrest and activation of the apoptotic pathways.

AIM:To investigate the relationship of autophagy and reactive oxygen species ( ROS) in multiple myeloma cell line RPMI-8226 stimulated with doxorubicin.METHODS:The RPMI-8226 cells were stimulated with doxo-rubicin at different doses, and untreated cells were used as control.The protein expression of beclin 1 and LC3 was detec-ted by Western blot.ROS production was analyzed by DCFH-DA fluorescence staining.After treated with or without 3-methyladenine (3-MA), the ROS production and apoptosis in RPMI-8226 cells were determined by DCFH-DA and flow cy-tometry, respectively.After treated with or without antioxidants tempol and N-acetyl-L-cysteine ( NAC) , the expression of beclin 1 and LC3 in RPMI-8226 cells was determined by Western blot.RESULTS:The protein levels of beclin 1 and LC3Ⅱ/LC3Ⅰwere increased in the RPMI-8226 cells stimulated with doxorubicin compared with untreated group.The ROS production was increased in the RPMI-8226 cells stimulated with 2 mg/L doxorubicin compared with untreated group.After treated with 3-MA, the ROS production and apoptosis in the RPMI-8226 cells stimulated with doxorubicin were increased compared with doxorubicin group.After treated with antioxidant NAC or tempol, the expression of beclin 1 and LC3 II/I in the RPMI-8226 cells stimulated with doxorubicin was decreased compared with doxorubicin group.CONCLUSION:The autophagy and ROS levels are increased in RPMI-8226 cells stimulated with doxorubicin.Inhibition of autophagy increases the ROS production and apoptosis of RPMI-8226 cells stimulated with doxorubicin.Inhibition of ROS production reduces doxorubicin-induced autophagy in multiple myeloma cells.

Objective To investigate the effect of long?term exposure to environmental cadmium on eight mineral element's metabolic balance of human body. Methods To choose a high cadmium area polluted by smelting and mining north of Guangdong province and a cadmium?free area with a similar economic level, and living and eating habit of residents as a contrast from April 2011 to August 2012. Stratified random sampling and clustered sampling method were adopted to choose the non?occupationally cadmium?exposed respondents who have lived in local area for more than 15 years, older than 40 years, having local rice and vegetable as the main dietary source, with simple and relatively stable diet, and without diabetes, kidney disease, thyroid disease, liver disease or other history of chronic disease. This study included 298 respondents, of whom 155 were in cadmium exposure group and 143 in control group. Questionnaires was used to acquire their health status and their morning urine samples were collected. Electrolytically coupled plasma mass spectrometry (ICP?MS) was used to test the concentrations of sodium (Na), magnesium (Mg), phosphorus (P), potassium (K), calcium (Ca), copper (Cu), zinc (Zn) and iodine (I). The Mann?Whitney U test method was used to compare the differences of concentrations of urinary cadmium, Na, Mg, P, K, Ca, Cu, Zn, I, and the ratio of Na to K (Na/K), Ca to P (Ca/P) between exposed group and control group.χ2 test was used to compare the abnormal rate of urinary cadmium between exposed group and control group. Pearson correlation and multiple regression method were used to investigate the relationship between urinary cadmium levels, gender, age, smoking, passive smoking, and minerals. Results The urinary cadmium level P50 (P25-P75) in exposed group was 5.45 (2.62-10.68)μg/g·cr, which was higher than that of the control group, which was 1.69 (1.22-2.36)μg/g · cr (Z=-10.49, P<0.001). The abnormal rate of urinary cadmium was 51.6%(80/155), which was higher than that of the control group (2.8%(4/143)) (χ2=87.56,P<0.001). The urinary Ca, Cu, Zn, and I level P50 (P25-P75) of exposed group were 173.80 (114.40-251.70), 20.55 (14.95-28.44), 520.23 (390.25-647.15), and 246.94 (203.65-342.97)μg/g · cr, which were higher than those in control group (142.42 (96.87-179.11), 15.44 (12.26-20.98), 430.09 (309.85-568.78) and 213.85 (156.70-281.63) μg/g · cr, respectively) (Z values were-4.33,-5.04,-3.47 and-4.24, all P values<0.001). The urinary P, K level P50 (P25-P75) of exposed group were 582.50 (463.20-742.8), 890.10 (666.00-1 305.40) μg/g · cr, which were lower than control group (694.50 (546.20-851.17), 1 098.58 (904.53-1 479.18) μg/g · cr) (Z values were-3.36,-4.02, all P values <0.001). on Based the results of Pearson correlation analysis, urinary cadmium was positively correlated with urinary Ca, Cu, Zn, and I, and the correlation coefficients were 0.31, 0.61, 0.38, and 0.25, respectively(all P values<0.05). Based on the results of multiple regression analysis, urinary cadmium levels contributed most to the metabolic balance of urinary Ca, Cu, Zn and I. The standardized regression coefficients were 0.31, 0.59, 0.39, and 0.24, respectively (all P values<0.001). Conclusion Long?term environmental exposure to cadmium affected the metabolic balance of Ca, Cu, Zn and I in human body.

Objective To investigate dynamic change of cadmium body burden and renal dysfunction among residents living in cadmium?polluted areas. Methods From April to July of 2011, the cadmium?polluted areas of northern Guangdong province in China was chosen as the study site. Based on the levels of cadmium pollution in soil and rice, the survey areas were divided into low exposed group (average concentration of cadmium was 0.15-0.40 mg/kg, 0.5-1.0 mg/kg in rice and soil, respectively) and high exposed group (average concentration of cadmium was >0.40 mg/kg, >1.0 mg/kg in rice and soil, respectively). Stratified random sampling and cluster sampling method of epidemiological investigations were carried out among 414 local residents who lived in cadmium exposure areas for more than 15 years, aged above 40, and without occupational cadmium exposure, including 168 and 246 residents in low and high exposed group, respectively. From March to June of 2014, 305 respondents of those who participated in 2011 were successfully traced, including 116 and 189 respondents in low and high exposed group, respectively. We used health questionnaires to acquire their health status. Home?harvested rice and vegetable samples were collected using quartering method for detection of cadmium level, including 190 rice samples, 161 vegetable samples in 2011 and 190 rice samples, 153 vegetable samples in 2014. Urine specimens of residents were collected for the detection of urinary cadmium and creatinine as well as renal dysfunction biomarkers, namely, N?acetyl?beta?D?glucosamidase (NAG) andβ2?microglobulin (β2?MG), respectively. In 2011 and 2014, Chi?square test was used to investigate the differences of abnormality of cadmium concentration in rice, vegetables and urinary cadmium,β2?MG,and NAG that were expressed as odds ratio (OR) and 95%confidence intervals (95%CI). Results In 2011 and 2014, cadmium concentration P50 (P25-P75) in rice was 0.43 (0.17-1.10) mg/kg,and 0.42 (0.20-1.14) mg/kg, respectively (Z=-0.77, P=0.440). In 2011 and 2014, cadmium concentrations P50 (P25-P75) in vegetables were 0.13 (0.07-0.34) mg/kg,and 0.25 (0.12-0.59) mg/kg, respectively, with abnormal rates of 38.5%(62/161) and 60.8%(93/153), respectively. In 2014, both average concentration and abnormal rate of cadmium in vegetables were higher than those in 2011 (Z=-4.69,P<0.001 andχ2=15.58, P<0.001). Concentrations of urinary cadmium P50 (P25-P75) in high exposed group were 7.90 (3.96-14.91)μg/g creatinine, 8.64 (4.56-17.60)μg/g creatinine in 2011 and 2014, respectively. Contrary to that in 2011, urinary cadmium of high exposed group was significantly increased in 2014 (Z=-2.80 ,P=0.005). In 2011 and 2014, concentrations of β2?MG, NAG P50 (P25-P75) were 0.15 (0.07-0.29)μg/g creatinine, 0.15 (0.07-0.45)μg/g creatinine,and 7.12 (5.05-10.65) U/g creatinine, 13.55 (9.1-19.84) U/g creatinine, respectively, with abnormal rates of 7.5% (23/305), 15.1% (46/305) ,8.2%(25/305) , and 33.8% (103/305), respectively. Compared with baseline in 2011, average concentrations ofβ2?MG, NAG significantly increased in 2014 (Z=-2.263,P=0.024 and Z=-12.52,P<0.001), and abnormal rates ofβ2?MG, NAG were also higher in 2014 (χ2=15.61,P<0.001 andχ2=64.72,P<0.001), with odds ratio (OR) of 2.00 (95%CI:1.23-3.24) and 4.12 (95%CI:2.87-5.92). Conclusion Environmental cadmium pollution of crops such as rice and vegetables in survey areas continued to remain high. Body burden of cadmium might kept at sustainably high levels and renal dysfunction was worsened after continuous, long?term cadmium exposure. Our results suggested that NAG might be more sensitive than β2?MG to serve as an indicator for an individual's future tubular function.