Objective To observe clinical efficacy of laparoscopy combined with gonadotropin-releasing hormone agonist (GnRH-a ) in the treatment of endometriosis (EMs).Methods 158 patients who underwent laparoscopic surgery and were diagnosed endometriosis in our hospital during Sep.2010 to Dec.2010 were chosen and divided into three groups:control group were treated with pure laparoscopic surgery,group A were treated with laparoscopic surgery and follow-up GnRH-a medication,and group B were treated with laparoscopic surgery,follow-up GnTH-a medication and add-back therapy.The total effective rates,recurrence rates,the changes of hormone levels before and after the treatment and adverse reaction rates after treatment were compared and analyzed to evaluate the efficacy of different treatments.Results The total effective rates of group A and group B (84.6%,86.2%) were significantly higher than that of control group (58.3%),and the difference was statistically significant (P=0.032,P=0.032).The recurrence rates of group A and group B (15.4%,13.8%)were significantly reduced compared with that of control group (41.6%)(P=0.012,P=0.012).The hormone levels decreased dramatically after treatment in three groups.The adverse reaction rate of group B was apparently reduced compared with that of group A,and the difference was statistically significant (P=0.001 ).Conclusion Laparoscopy combined with GnRH-a medication was a safe and effective treatment for endometriosis.The application of GnRH-a after laparoscopy can significantly increase the total effective rate of the operation and reduce the postoperative recurrence rate.For the patients who need to take long-term GnRH-a treatment,add-back therapy need to be given to decrease its adverse reaction and recurrence rate,or to delay its recurrence,thus could improve patients' living qualities significantly.

The intrauterine growth retardation (IUGR) model was established by maternal nutrition restriction during mid- to late-gestation. IUGR rats had both impaired pancreatic development and islet β-cell dysfunction. As the animals grew, the rats gradually showed impaired glucose tolerance and decreased insulin sensitivity.

Genechip was applied to explore gene expression profile of islets in rats at various stages of pregnancy. Compared with the normal control group, differential expressions of hundreds of genes were detected during pregnancy. Reg3α gene expression was markedly increased during pregnancy, which may be related to islet regeneration.

Objective To determine the reference intervals for thyroid function tests during the second half of pregnancy (20-40 gestational weeks),and to assess the relationship between thyroid peroxidase antibody (TPOAb) levels and the incidence of gestational thyroid diseases.Methods Levels of thyroid stimulating hormone (TSH),free thyroxine (FT4),TPOAb and urinary iodine excretion were determined in 4 729 pregnant women,who received prenatal health care at First Affiliated Hospital of Nanjing Medical University from July 2011 to August 2013.Among these women,2 568 were selected using the recommendations of the American National Academy of Clinical Biochemistry,and were divided into five groups according to their gestational age:≥ 20 to ＜24 weeks (682 cases),≥ 24 to ＜28 weeks (1 322 cases),≥ 28 to ＜32 weeks (178 cases),≥ 32 to ＜36 weeks (185 cases) and ≥ 36 to ≤ 40 weeks (201 cases).Reference intervals of thyroid function tests in the second half of pregnancy were calculated.The reference values of thyroid functions in different gestational weeks were compared,and the reference intervals of thyroid functions in the second half of pregnancy were determined.The effects of maternal age and positive TPOAb on gestational thyroid diseases were analyzed.A non-parametric test,analysis of variance or Chi-square test was used for statistical analysis.Results (1) Reference intervals for maternal thyroid function in the second half of pregnancy in our hospital were established [TSH:0.65-5.27 mU/L and FT4:8.74-14.84 pmol/L].(2) The percentage of thyroid diseases was higher using the non-pregnancy reference intervals (TSH:0.27-4.20 mU/L and FT4:12.00-22.00 pmol/L) than using the pregnancy reference intervals [64.0％ (3 025/4 729) vs 16.1％ (763/4 729),x2=47.465,P ＜ 0.01],which manifested as a higher rate of clinical hypothyroidism and simple hypothyroxinemia [5.4％ (255/4 729) vs 0.4％ (20/4 729),x2=14.321;54.1％ (2 560/4 729) vs 9.1％ (429/4 729),x2=47.108;both P＜0.01] and a lower rate of subclinical and clinical hyperthyroidism [1.2％ (58/4 729) vs 3.3％ (155/4 729),x2=6.650;0.3％ (13/4 729) vs 0.6％ (27/4 729),x2=2.062;both P＜0.05].(3) The incidence of clinical hypothyroidism and simple hypothyroxinemia in pregnant women aged ＞30 years was higher than in those aged ≤ 30 years [0.7％ (10/1 377) vs 0.3％ (10/3 352),x2=4.257;11.7％ (161/1 377) vs 8.0％ (268/3 352),x2=16.102;both P＜0.05].The incidence of clinical hypothyroidism and clinical hyperthyroidism in TPOAb positive women was higher than that in TPOAb negative women [2.7％ (9/335) vs 0.3％ (11/4 394),x2=44.009;3.9％ (13/335) vs 1.2％ (52/4 394),x2=16.784;both P＜0.01].Conclusions The established pregnancy-specific reference ranges of thyroid function tests can reduce the missed diagnosis and misdiagnosis of gestational thyroid diseases.Maternal age ＞30 years and positive TPOAb may increase the risk ofgestational thyroid diseases.

Objective To implement the finite discontinuity?volumetric modulated arc therapy ( FD?VMAT) in the Pinnacle planning system, and to investigate its clinical significance. Methods Eight patients with thoracic esophageal cancer in our hospital were enrolled as subjects. FD?VMAT was fulfilled in the Pinnacle planning system using a developed program. FD?VMAT, VMAT, and fixed?field intensity?modulated radiotherapy ( IMRT ) plans were designed for each patient. The conformity index ( CI ) and homogeneity index ( HI) of the planning target volume ( PTV) ,doses to organs at risk,passing rate for plan verification,number of monitor units,and treatment time were used to evaluate the plans. Comparison between different plans was made by paired t test. Results For the PTV,there was no significant difference in CI between FD?VMAT and VAMT ( P=0?186 );FD?VMAT had a significantly worse HI than VMAT ( P=0?001);however,both the CI and HI were significantly improved in FD?VMAT than in IMRT ( P=0?006, 0?002) . Compared with IMRT, FD?VMAT, retaining the advantage of VMAT, had pulmonary V20 and V30 significantly reduced by 19?79% and 20?32%,respectively (P=0?000,0?000).For the pulmonary low?dose regions (≤V5 ) ,FD?VMAT retained the advantage of IMRT and had lower doses than VMAT. Particularly, pulmonary V2 was significantly reduced by 16?79%(P=0?000).The mean lung dose was significantly lower in FD?VMAT than in VMAT or IMRT (P=0?001,0?000).There were no significant differences in D1cc to spinal cord PRV,heart V30,or passing rate for plan verification between the three therapies. The heart V40 and mean heart dose in FD?VMAT were similar to those in VMAT (P=0?175,0?468),but significantly lower than those in IMRT ( P=0?021,0?002) . FD?VMAT had a larger number of monitor units and longer treatment time than VMAT. Compared with IMRT, the number of monitor units and treatment time were reduced by 13?6% and 49?6% in FD?VMAT,respectively. Conclusions Compared with VMAT and IMRT, the application of the developed FD?VMAT in the treatment of thoracic esophageal cancer can further reduce the lung dose while keeping the PTV coverage,protection of the heart and spinal cord,and high efficacy. FD?VMAT is a new therapy available for thoracic esophageal cancer.

Objective:To comprehensively evaluate the performance of the iterative cone beam CT (iCBCT) imaging mode of Varian linear accelerators and to explore its specific advantages in clinical application.Methods:The kV cone beam CT (CBCT) imaging systems of Halcyon 2.0, Edge, and VitalBeam linear accelerators from Tianjin Medical University Cancer Institute & Hospital were selected, among which Halcyon 2.0 and Edge were equipped with the iCBCT imaging mode. The Penta-Guide phantom was used to evaluate the registration accuracy of iCBCT imaging modes. The accuracy of treatment couch position was measured by a ruler. The image quality of the iCBCT and conventional CBCT modes of various imaging devices were analyzed using the CatPhan604 phantom. The imaging beam-on time and reconstruction time were measured to assess image acquisition efficiency. The uniformity, spatial resolution, contrast, contrast-to-noise ratio (CNR), image acquisition time and reconstruction time between two imaging modes were statistically analyzed by t-test. Results:The maximum deviations of image registration measurement results of the iCBCT mode for Halcyon 2.0 and Edge accelerators compared to the standard values were 0.7 mm and 0.6 mm, respectively. The treatment couch position error of all devices was less than 1 mm. The iCBCT images under head scanning protocol primarily improved the uniformity and CNR. Compared to conventional CBCT images, Halcyon iCBCT increased the uniformity and CNR by 2.50% ( P<0.001) and 78.85% ( P<0.001), respectively, while Edge increased them by 2.18% ( P<0.001) and 86.42% ( P<0.001), both superior to VitalBeam CBCT images. Under pelvis scanning protocols, iCBCT images primarily improved the CNR compared to conventional CBCT images. Halcyon and Edge iCBCT increased the CNR by 113.57% ( P<0.001) and 133.87% ( P<0.001), respectively, both superior to VitalBeam CBCT images. In terms of image acquisition efficiency, the average reconstruction times for Halcyon and Edge iCBCT images increased by 7.28 s and 15.53 s, respectively, and the total image acquisition time of Halcyon accelerator was the shortest. Conclusions:While ensuring the registration accuracy, iCBCT imaging mode can significantly improve the CNR of images and improve the uniformity of images under head scanning protocol. The Halcyon imaging system can enhance image acquisition efficiency.

Small-molecule anticancer drugs inhibited tumor growth based on targeted inhibition of specific proteins, while most of oncogenic proteins are "undruggable". Proteolysis targeting chimeras (PROTAC) is an attractive and general strategy for treating cancer based on targeted degradation of oncogenic proteins. This review briefly describes the peptide-based PTOTAC and small molecule-based PROTAC. Subsequently, we summarize the development of targeted delivery of PROTAC, such as targeting molecule-mediated targeted delivery of PROTAC, nanomaterial-mediated targeted delivery of PROTAC and controllable activation of small-molecular PROTAC prodrug. Such strategies show potential application in improving tumor selectivity, overcoming off-target effect and reducing biotoxicity. At the end, the druggability of PROTAC is prospected.
Humans ; Proteolysis Targeting Chimera ; Nanostructures ; Neoplasms/drug therapy* ; Proteolysis

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective: To understand the consistency of ALK Ventana-D5F3 immunohistochemistry (IHC) interpretation in Chinese lung adenocarcinoma among histopathologists from different hospitals, and to recommend solution for the problems found during the interpretation of ALK IHC in real world, with the aim of the precise selection of patients who can benefit from ALK targeted therapy. Methods: This was a multicenter and retrospective study. A total of 109 lung adenocarcinoma cases with ALK Ventana-D5F3 IHC staining were collected from 31 lung cancer centers in RATICAL research group from January to June in 2018. All cases were scanned into digital imaging with Ventana iSCANcoreo Digital Slide Scanning System and scored by 31 histopathologists from different centers according to ALK binary (positive or negative) interpretation based on its manufacturer′s protocol. The cases with high inconsistency rate were further analyzed using FISH/RT-PCR/NGS. Results: There were 49 ALK positive cases and 60 ALK negative cases, confirmed by re-evaluation by the specialist panel. Two cases (No. 2302 and No.2701) scored as positive by local hospitals were rescored as negative, and were confirmed to be negative by RT-PCR/FISH/NGS. The false interpretation rate of these two cases was 58.1% (18/31) and 48.4% (15/31), respectively. Six out of 31 (19.4%) pathologists got 100% accuracy. The minimum consistency between every two pathologists was 75.8%.At least one pathologist gave negative judgement (false negative) or positive judgement (false positive) in the 49 positive or 60 negative cases, accounted for 26.5% (13/49), 41.7% (25/60), respectively, with at least one uncertainty interpretation accounted for 31.2% (34/109). Conclusion There are certain heterogeneities and misclassifications in the real world interpretation of ALK-D5F3 IHC test, which need to be guided by the oncoming expert consensus based on the real world data.