Objective To evaluate the effects of 131I treatment for Graves hyperthyroidism patients with leucopenia and the alteration of WBC levels after treatment.Methods A total of 257 Graves hyperthyroidism cases were retrospectively studied after 131I treatment.Based on baseline WBC count,119 cases with WBC count ＜4.0 × 109/L before 131I treatment were diagnosed with leucopenia and 138 cases had normal WBC.There were no significant differences in age,weight of thyroid,131I uptake rate in 24 h,dose of 131I and course of the disease between the two groups (all t ＜ 0.972,all P ＞ 0.05).WBC,lymphocyte,neutrophil and platelet counts were recorded before and 1,3,6 and 12 months after 131I therapy.The therapeutic effects were graded as clinical cure,improvement,invalidation and hypothyroidism.Statistical analyses,including independent samples t test,x2 test and one-way analysis of variance,were performed using SPSS 13.0.Results The WBC levels in the leucopenia group were (3.49 ± 0.43) × 109/L,(4.06 ±0.98) × 109/L,(4.20 ±1.04) × 109/L,(4.37 ±0.93) × 109/L and (4.88 ± 1.20) × 109/L before 131I treatment and 1,3,6,12 months after 131I treatment,respectively; while,those in the normal WBC group were (5.70 ± 1.08) × 109/L,(5.50 ± 1.14) × 109/L,(5.74 ±0.99) × 109/L,(5.95 ± 1.14) × 109/L and (6.07 ± 1.17) × 109/L,respectively.There was no statistically significant difference of WBC levels before and 1 month after 131 I treatment (t =1.662,P ＞ 0.05) in the normal WBC group,but WBC levels at those timepoints were significantly different in the leucopenia group (t =3.816,P ＜ 0.05).In the leucopenia group,there was no significant change of lymphocytes before and after 131I treatment,while the average neutrophil count showed an increasing trend during the 1,3,6 and 12 months after 131I treatment (F =40.583,t:1.468-11.264,all P ＜ 0.05).The average platelet counts at 6 and 12 months after 131I treatment were (187.80 ± 36.03) × 109/L and (206.88 ± 26.04) × 109/L respectively,which were higher than that before 131I treatment (F =9.735,t =2.604,4.892,all P ＜0.05).In the normal WBC group,there were no statistical differences of WBC changes before and after 131I treatment except for a lower lymphocyte count at 1 month after 131I treatment than that at baseline ((1.79 ± 0.37) × 109/L vs (1.99 ±0.63) × 109/L;F =12.868,t =3.284,both P ＜ 0.05).The treatment effects of the two groups were not significantly different (x2 =0.739,P ＞ 0.05).Conclusions 131I treatment presents similar therapeutic effects on Graves hyperthyroidism patients with leucopenia and those with normal WBC levels.WBC levels in patients with leucopenia may recover to baseline during the post-treatment follow-up.Thus 131I treatment is a safe and effective method for Graves hyperthyroidism patients with leucopenia.

The characterization and management of oral and maxillofacial spaces infections in diabetic patients were studied in order to determine the pattern of this clinical condition and formulate a management plan.There were 31 cases with average age of 61 years(s=9);the mean hospitalization time was 14 days(s=6);the average fasting blood glucose level on admission was 10.4 mmol/L.Of the 31 patients 20 were multiple-space infections and 11 were single-space infections.13 patients had major complications during admission.Odontogenic infection was the most common cause of the space infections.Streptococcus viridians and staphylococcus aureus were common organisms(5/19,4/19)identified through pus and/or blood cultures.Early surgical incision and drainage,perfect blood glucose control,intravenous antimicrobial therapy,preventing asphyxia and managing major complications are necessary and effective approaches for the management plan.

Objective To analyze the pregnancy outcomes and effect on fertility in women with Graves' disease after 131I therapy and the health status of their newborns.Methods From year 2009 to 2012,a total of 102 female patients with Graves' disease,who were pregnant during propylthiouracil (PTU)/L-thyroxine (euthyrox) maintenance treatment,were retrospectively recruited.The subjects were divided into 131I therapy group (n=57) and non-131I therapy group (n=45).The time interval between 131I (non-131I) therapy and getting pregnant were at least 6 months.They were followed for their pregnancy outcomes.During the pregnancy period,recorded parameters included serum thyroid biochemistry,dose of PTU/euthyrox,health conditions of the newborns and termination of pregnancy.Medication compliance,delivery mode,baby gender and body weight between the 2 groups were compared byx2 test,Mann-Whitney u test,Fisher exact test and two-sample t test.Results Ninety-seven patients had normal labor.In 131I therapy group and non-131I therapy group,15 vs 22 patients were treated by PTU,31 vs 18 by euthyrox and 11 vs 5 without any medication during pregnancy (x2=5.69,P＞0.05).The medical compliance (PTU and euthyrox: u=163.50,233.50,both P＞0.05) was similar between the 2 groups.The delivery mode (natural labor/cesarean: 36/19 vs 28/14,x2 =0.016),baby gender (male/female: 32/23 vs 18/24,x2 =2.239) and body weight ((3.18t0.47) vs (3.07±4.17) kg,t=1.154) were also similar between the 2 groups (all P＞0.05).Condusion Women of reproductive age with Graves' disease were found to have normal pregnancy after 131I therapy,on the condition that their thyroid function could be reasonably controlled and maintained by the proper medication before and during pregnancy.

Objective:To detect the immune response in mice inoculated by DNA vaccine expressing chimeric gene gag gp120 of HIV 1.Methods:After BALB/C mice were immunized by the eukaryotic expression plasmid pVAXGE,the numbers of T lymphocyte subgroups of spleen,the killing rate of specific CTL from the immunized mice and the titers of serum antibodies during the different time were observed.Results:The lymphocytes of the immunized group by recombinant plasmid pVAXGE proliferated,the specific CTL killing rate of spleen was higher significantly than those of the control group( P

Objective To evaluate the safety and efficacy of proton and carbon-ion radiotherapy (RT) for stage Ⅰ non-small cell lung cancer (NSCLC) with pencil beam scanning technique.Methods From August 2014 to December 2015,10 patients with stage Ⅰ NSCLC who were inoperable or refused surgery were treated by proton +/-carbon-ion RT.Primary lesions were irradiated using 2-4 portals with 45-degree beams.A total dose of 50-70 GyE/10 fractions,60-64 GyE/15-16 fractions,and 66-72 GyE/22-24 fractions were administered to patients based on tumor location (4 peripheral,3 middle,and 3 central lesions,respectively).Results At the last follow-up in December 2016 with the median follow-up of 18.1 (11.9-28.1) months,local control was found in all patients per CT or PET/CT scanning(6 complete response,3 partial response,and 1 stable disease).However,2 patients with local control (1 partial response and 1 stable disease) experienced a distant failure at 8.7 and 24.9 months after RT,respectively.There was no RT-related Grade 3-5 toxicity in all patients.Grade 2 toxicities were only found in 2 patients (acute skin reaction and leucopenia,respectively).At 1,3-5 months after RT,the pulmonary function tests showed a slightly increase in FVC,FEV1 and DLCO-sb compared with those before RT without statistical significance (P ＞ 0.05).Conclusions The particle RT using pencil beam scanning technique was safe,and yielded encouraging outcome for patients with stage I NSCLC who were inoperable or refused surgery.Further follow-up and prospective clinical studies are warranted in the future.

The new American Thyroid Association (ATA) guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis was published in 2016.Compared to the 100 pieces of evidence-based recommendations in 2011 edition guidelines,the 2016 edition guidelines included 124 pieces of evidence-based recommendations,which made the diagnosis and therapy of thyroid diseases more detailed.As one of the most important treatment for Graves disease (GD),131I therapy was explained more completely in the 2016 edition guidelines,including the indication,the determination of dose,the radiation protection,the reasonable application in children and so on.The purpose of this paper is to interpret the 2016 edition guidelines about the diagnosis and therapy of thyroid diseases in the view of nuclear medicine,focusing on the updated contents.

BACKGROUND: Embryonic stem cells fESCs) develop from early blastular inner cell mass.Under proper condition,ESCs can maintain undifferentiated state in vitro,normal diploid nuclear type,and proliferative potential.In addition,ESCs possess multi-directional differentiation capacity and can differentiate into all sorts of cells of three germ layers. OBJECTIVE: To investigate the feasibility of directed differentiation of ESCs towards thyroid cells in vitro as well as related molecular expression. DESIGN,TIME AND SETTING: A cell-based observational experiment was performed at the Bank of Cord Blood,Second Hospital Affiliated to Sun Yat-sen University between January 2004 and December 2006.MATERIALS: Balb/c pregnant mice at pregnancy 12.5-14.5 days were used for preparation of embryonic fibroblast feeder layer.E14 mouse embryonic stem cell (ESC) strains were gifted by professor Xu from Harvard University.METHODS: Murine El4 ESCs were cultured in methylcellulose semisolid medium to form embryoid bodies (Ebs).These Ebs were transferred for further inductive culture with the stepwise addition of growth factors- thyrotropin (TSH),insulin and kalium iodidum (KI).The cultured thyroid cells of adult Kunming mice were taken as positive control.MAIN OUTCOME MEASURES: ①Cellular morphological change in the process of differentiation.② Detection of expression levels of TSHR,PAX8,TTF-2,and TIF-1 by immunofluorescence assay.③ Detection of expression levels of TSHR,PAX8,NIS,TPO,and Tg by reverse transcription-polymerase chain reaction (RT-PCR).RESULTS: The differentiated cells had clear boundary,exhibiting round,oval,shuttle-shaped,or polygon adhesive growth.On day 6 of inductive ifferentiation,the differentiated cells showed the expression of PAX8,NIS,TPO,Tg,and TSHR,the specific gene of thyroid ceils.On day 8 of inductive differentiation,the expression of TSHR,TIF-1,PAX8,and TIF-2 was detectable in the differentiated cells with morphous similar to thyroid cells.CONCLUSION: ESCs can differentiate towards thyroid cells under given inductive conditions.

Objective To isolate and identificate Streptomyce strain from cow dung and observe its antimicrobial activity. Methods Strains were isolated from cow dung by dilution coating method.Strong antibacterial strains were screened out by agar block method with fixed Staphylococcus aureus and Escherichia coli as indicative bacteria.The strains were identified based on physiological and biochemical characteristics as well as 16S rDNA gene sequence analysis.Active antibacterial fermentation broth substance was determined by disk diffusion method,and antibacterial active substance of strains fermentation broth was extracted by water-saturated n-butanol.Antibacterial substance of strains was identified by Molish reaction,biuret test and ninhydrin reaction. Results Eight strains were isolated from cow dung and one strong antibacterial strain was screened out and named B5-2,identified as Streptomyces.The results showed that the strain had the highly antibacterial effect on Staphylococcus aureus,Escherichia coli,Citrobacter freundii,Enterobacter cloacae,Klebsiella pneumoniae,Enterobacter aerogenes.The strain antibacterial active substance of fermentation broth preliminary analysis showed that strong antibacterial active substance of B5-2 was the water-soluble substance.Antibacterial substance of B5-2 was preliminarily identified as glycoside and protein by Molish reaction,biuret test and ninhydrin reaction. Conclusion The strain isolated have a strong inhibition effect on clinical pathogenic bacteria in clinical practice.

Objective:To explore the clinical value of 18F-fluoromisonidazole (FMISO) PET/CT hypoxia imaging in early response to heavy ion radiotherapy in patients with non-small cell lung cancer(NSCLC). Methods:From April 2018 to January 2021, the 18F-FMISO PET/CT images of 23 NSCLC patients (19 males, 4 females; age (64.9±10.3) years) who received heavy ion radiotherapy in Shanghai Proton and Heavy Ion Center were retrospectively analyzed. The evaluation parameters included tumor volume (TV), tumor to background ratio (TBR) before and after radiotherapy. Patients were divided into hypoxia group and non-hypoxia group with the baseline TBR value≥1.4 as hypoxia threshold. Wilcoxon signed rank test was used to compare the differences of TV and TBR before and after radiotherapy in 2 groups. Results:Of 23 NSCLC patients, 17 were hypoxia and 6 were non-hypoxia. Compared with the baseline, TV after the radiotherapy (59.44(22.86, 99.43) and 33.78(8.68, 54.44) cm 3; z=-3.05, P=0.002) and TBR after the radiotherapy (2.25(2.09, 2.82) and 1.42(1.24, 1.67); z=-3.39, P=0.001) of the hypoxia group were significantly lower, while TV (16.19(6.74, 36.52) and 8.59(4.38, 25.47) cm 3; z=-1.57, P=0.120) and TBR (1.19(1.05, 1.27) and 1.10 (0.97, 1.14); z=-1.89, P=0.060) of the non-hypoxia group decreased with no significant differences. Conclusions:Hypoxic NSCLC tumors are sensitive to heavy ion radiation. Compared with non-hypoxic tumors, hypoxic tumors respond more quickly, and a significant reduction in TV can be observed early after radiotherapy. Heavy ion radiation can significantly improve tumor hypoxia.

Objective:To compare dose distributions between photon versus proton and carbon ion radiotherapy (particle therapy, PT) among patients with gross tumors, and to evaluate the safety and efficacy of PT for thymic malignancies (TM).Methods:From Sept 2015 to Aug 2018, 19 patients with TM who underwent non-palliative PT using pencil beam scanning technique in our hospital and had at least one follow-up were retrospectively analyzed. Diseases staged from Ⅰ-Ⅳ B including 15 Ⅲ-Ⅳ B. All the patients had pathological diagnosis with 10 thymomas, 6 carcinomas and 3 neuroendocrine tumors of the thymus. A set of dosimetric comparisons were conducted in patients with gross tumors at a total dose of 66 GyE, in 33 fractions for photon or proton beams and in 22 fractions for carbon ion beams. Five patients without any local treatment and 7 patients after R2 resection received radical radiotherapy of proton 44.0-48.4 GyE in 20-22 fractions plus carbon ion 21.0-23.1 GyE in 7 fractions, 1 case after complete resection (R0 resection) had proton 45 GyE in 25 fractions, 5 cases after R1 resection had proton 60.0-61.6 GyE in 28-30 fractions and 1 case of recurrence after postoperative radiotherapy had only carbon ion 60 GyE in 20 fractions. Results:The median follow up time was 19.0 (2.4-42.9) months. There were 13 patients with gross tumors, with a median largest diameter of 5.7 (2.7-12.8) cm. The dosimetric study showed that proton and carbon-ion plans significantly reduced the maximum dose to the spinal cord, the mean doses to the organs at risk (OARs) including the lung/heart/esophagus, and the integral dose of the exposed area about 25%-65% compared to photon plans. No other toxicities ≥ grade 3 were observed except one myocardial infarction (grade 4 late toxicity). There was no local failure observed. Metastasis to regional lymph node, lung, pleura, skull base, bone or liver occurred in 4 patients with Ⅲ-Ⅳ B stage disease in 6.1-22.8 months after treatment. The 2-year local control and overall survival rates were 100%, disease free survival and distant metastasis free survival rates were 64.6%. Conclusions:For TMs, PT has significant advantages over photon in terms of sparing OARs, and is safe and effective in patients with TMs after short-time follow-up.