Objective To investigate the level Ⅰb contouring,dose analysis and regional recurrence in level Ⅰb lymph node-negative (Ⅰb-negative) nasopharyngeal carcinoma (NPC) patients treated by intensity-modulated radiotherapy (IMRT).Methods One hundred ninety newly-diagnosed,Ⅰb-negative NPC patients treated by IMRT were enrolled.Level Ⅰb contouring and dose prescribing in this cohort were classified into planned prophylactic irradiation (PPI) group (56 cases) and non-planned prophylactic irradiation (non-PPI) group (134 cases).The mean dose (Dmean) of the level Ⅰb bilaterally and submandibular glands (SMGs) was recorded for comparison.Results After a median follow-up of 47 months,there was no level Ⅰb regional recurrences noted in the entire group.The mean doses of level Ⅰb and the submandibular glands were significantly lower in the non-PPI group than those in the PPI group as follows:(50.81±5.37) Gy vs (59.68±3.32) Gy for the left level Ⅰb,(51.55±5.02) Gy vs (59.66±3.85) Gy for the left submandibular gland,(51.55±5.02) Gy vs (59.66±3.85) Gy for the right level Ⅰb and (57.25±4.69) Gy vs (63.41±2.88) Gy for the right submandibular gland (all P =0.000).Conclusion In this retrospective analysis of non-randomized single institute data,it seems unlikely that PPI to level Ⅰb is necessary in Ⅰb-negative NPC patients treated by IMRT.

Objective To identify the sequence of hepatitis B virus S gene"a"determinant in patients with positive HBsAg and anti-HBs.Methods Nested-PCR Was used to amplify the HBV S gene in 4 patients with positive HBsAg and anti-HBs,and the PCR products were sequenced directly or after cloning.The sequences of"a" determinants were then analyzed by sequence alignment.Results Direct sequencing of PCR products showed that there was one amino acid (aa)residue in"a"determinant less conserved region emerging polymorphism in all 4 patients.Clone sequencing showed that aa residue at 126 of "a"determinant in patient 1 miSht be Thr,Ile and Set,at 134 might be Phe and Set;the aa at 126 in patient 2 misht be Ala and Thr.and in patient 3 might be Ile and Asn;aa polymorphism was not found in patient 4.Conclusion The polymorphism of"a"determinant in HBV S gene might be associated with positivity of both HBsAg and anti-HBs in hepatitis B patients.

Objective To study the effects of Panax Notoginseng Saponins (PNS) on the damaged expression of ZO-1 of brain microvascular endothelial cells caused by Aβ42.MethodsBrain microvascular endothelial cells were divided into normal control group, model group, PNS low-, medium- and high concentration groups. They were incubated for 24h in 5% CO2 incubator at 37℃ . Then cell vitality was detected by MTT colorimetric method and ZO-1 protein expression was tested by Western blot.Results Stimulation of Aβ42 reduced the activity of microvascular endothelial cells (P<0.01) and suppressed the expression of ZO-1 protein (P<0.01). Compared with the model group, the activity of microvascular endothelial cells of PNS groups, especially the high and medium dose groups (P<0.05), and increased the ZO-1 protein expression. Conclusion PNS can partly recover the barrier function of blood brain barrier through inhibiting the decrease of the activity of microvascular endothelial cells caused by Aβ42.

Objective To investigate relationship among Brachial-ankle pulse Wave Velocity (baPWV),Homocysteine (Hcy),Serum Matrix Metallopro Teinases-9 (MMP-9) and coronary heart disease.Methods Sixty-six cases of patients diagnosed as coronary heart disease according to the coronary angiography showed any one of the main coronary arteries (left main,left anterior descending,left circumflex artery,right coronary artery) diameter stenosis≥ 50％ were selected into coronary heart disease from June 2009to March 2011 hospitalized in the Second Affiliated Hospital of Ningxia Medical Cardiology.And 40 cases of healthy people who had medical examination over the same period were selected into the normal control group.The 66 cases of patients were further divided into single-branch-affected group (n =18),two-branchaffected group(n =25) and multi-branch-affected group (n =23) according to the branches of coronary artery pathological changes shown in coronary angiography.Detected and compared baPWV,Hcy and MMP-9 among these groups.Results The baPWV,Hcy and MMP-9 in coronary heart disease group were significantly higher than those in the control group (baPWV:(2132 ±240) cm/s vs (1360 ±81) cm/s,t =23.97,P ＜0.01 ;Hcy:(14.32 ± 5.20) μmol/L vs (6.50 ± 1.40) μmol/L,t =11.54,P ＜ 0.01 ; MMP-9:(768.0 ± 95.3) μg/L vs (228.0 ±56.2) μg/L,t =36.69,P ＜0.01) ;The baPWV,Hcy and MMP-9 in multi-branch-affected group were significantly higher than those in single-branch-affected and two-branch-affected group; The baPWV,Hcy and MMP-9 in two-branch-affected group were higher than those in single-branch-affected group (baPWV (2041 ±168) cm/s vs (1873 ± 150) cm/s vs (1560 ± 172) cm/s,F =45.36,P ＜0.01 ;Hcy:(21.31 ±6.30) μmol/L vs (15.32 ± 5.80) μmol/L vs (10.50 ± 3.20) μmol/L,F =36.18,P ＜ 0.01 ;MMP-9:(1042.0 ± 180.2) μg/L vs (940.0 ± 175.8) μg/L vs (723.0 ± 102.2) μg/L,F =41.06,P ＜ 0.01).The serum MMP-9 was significantly positive correlated with baPWV and Hcy (r =0.630,P ＜0.01 ;r =0.351,P ＜0.05) ;The Hcy was significantly positive correlated with baPWV (r =0.475,P ＜ 0.05) in the coronary heart disease group.Conclusion The baPWV,Hey and MMP-9 were related with the degree of artery stenosis in coronary heart disease.Combined detection of these three markers can be used to assess the risk of coronary heart disease.

BACKGROUND:Hypertrophic differentiation of chondrocytes is the sign of starting endochondral ossification, and it is also an essential step in endochondral ossification, which is a cascade reaction and difficult to be blocked once started. The end result is the formation of bone structure. RNA interference is a post-transcriptional gene silencing. Relevant studies have shown that the use of RNA interference to block the expression of core binding factorα1 (Cbfα1) can effectively inhibit the formation of heterotopic ossification. OBJECTIVE:To use RNA intereference technology to suppress Cbfα1 expression so as to achieve the purpose of blocking the hypertrophic diferentiation of chondrocytes. METHODs: We constructed an adenovirus containing siRNA against Cbfα1 (Ad-Cbfα1-siRNA). Retinoic acid and interleukin-1α were used to induce hypertrophic differetiation of chondrocytes, and then Ad-Cbfα1-siRNA was utilized to inhibit the hypertrophic differentiation of chondrocytes. Immunohistochemistry method was used to analyze the expression of Cbfα1. RESULTS AND CONCLUSION:After induction with retinoic acid and interleukin-1α, the chondrocytes in the negative control virus group appeared to have hypertrophy and the expression of Cbfα1 was positive. In the Ad-Cbα1-siRNA group, the expression of Cbfα1 was negative. These findings suggest that the inhibition of Cbfα1 by RNA interference can be a powerful way to prevent the hypertrophic differentiation of chondrocytes .

In this paper, we reviewed the long history of the use of modern fresh Chinese Medicine (FCM) and summarized the development of fresh Chinese Medicine preparation (MFCMP) in recent years. Combined with domestic and foreign examples, the characteristics the technology and preparations of MFCMP are explained. Meanwhile, as for the development of FCM and MFCMPs, the problems faced and feasible solutions are put forward. Finally, based on China.s national conditions, the development trend of MFCMPs is prospected.

Objective: To explore age-based clinical and immune parameters in Henoch-Schönlein purpura (HSP) to determine clinically useful markers reflecting disease characteristic. Methods: A cohort of 502 patients with HSP were enrolled into this retrospective study to evaluate their clinical and immune data. Results: Majority HSP cases occurred at age ≤14 years and showed significant immune imbalances of ESR, CD3⁺ cells, CD4⁺ cells, CD3^-CD16⁺CD56⁺ cells, CD4⁺/CD8⁺ cells, IgG, IgA, IgM, IgE, complements C3/C4 and ASO in the acute phase. Compared to patients aged >14 years, symptoms of joint were more frequent at disease onset in patients aged ≤14 years (20.8% vs 7.6%, χ²=13.547, P<0.001) , and involvement of digestive tract and joint were also more frequent (57.4% vs 33.8%, χ²=24.106, P<0.001; 55.9% vs 32.5%, χ²=23.768, P<0.001, respectively) , but not for involvement of kidney (21.4% vs 51.3%, χ²=42.440, P<0.001) . The patients aged ≤14 years had distinct immune state, reductions of CD3⁺ cells, CD4⁺ cells and IgG were more frequent than patients aged >14 years, also increase of ASO (33.1% vs 20.0%, χ²=6.656, P=0.010) , but not increase of IgA (2.6% vs 39.4%, χ²=15.582, P<0.001) . In addition, reduction of IgG and increase of IgE were positively associated with digestive tract involvement (P<0.001, P=0.001, respectively) , reduction of CD3⁺CD4⁺ cells and normal IgM were positively associated with joint involvement (P=0.004, P=0.003, respectively) , increase of CD3⁺CD8⁺ cells and normal CD3⁺ cells were positively associated with kidney involvement (P=0.032, P=0.014, respectively) . Conclusion HSP showed significant immune imbalance in the acute phase, patients between aged ≤14 and >14 years had distinct clinical and immune characteristic, and abnormal immune parameters were significantly associated with organ involvements.

Objective:The study was designed to evaluate the efficacy in polycystic ovary syndrome (PCOS) of glucagon-like peptide-1 receptor agonists (GLP-1RA), metformin combined with thiazolidinediones, α-glucosidase inhibitor, and inositol.Methods:Eligible studies were searched in databases of PubMed, EMBase, Cochrane Library, Wanfang data, and CNKI based on population, interventions, comparisons, outcomes, and study design (PICOS) principle (inception to Nov 2020). Two researchers independently screened randomized controlled trials in strict accordance with the inclusion and exclusion criteria, extracted basic information and outcomes of included studies, and used Cochrane risk of bias tool to evaluate the methodological quality of the literature. Network meta-analysis was conducted by STATA 14.0. Continuous variables without dimensional differences were calculated by weighted mean difference and 95% CI, and continuous variables with dimensional differences were calculated using standardized mean difference and 95% CI. Results:A total of 27 studies with 1 445 patients were included in this study. Network meta-analysis showed that acarbose presented a better efficacy than other interventions in reducing total testosterone [surface under the cumulative ranking curve (SUCRA): 89.4%]. GLP-1RAs may have the best efficacy in reducing body mass index and homeostasis model assessment for insulin resistance (HOMA-IR; SUCRA: 99.1%, 89.2%, respectively), while using inositol may be a good choice to reduce serum fasting insulin, HOMA-IR, blood total cholesterol, and blood triglycerides (SUCRA: 94.5%, 85.4%, 96.6%, and 82.8%, respectively).Conclusions:Acarbose may have advantages over other antihyperglycemic drugs in lowering blood testosterone. GLP-1RAs are more helpful to improve body mass index and HOMA-IR in PCOS patients. Inositol, as an insulin sensitizer, has a favorable effect on reducing fasting insulin, HOMA-IR, blood total cholesterol, and blood triglycerides, and there are no reports of side effects in current researches. Further study is still needed to confirm its efficacy.

Objective: To study the dosimetric characteristics and plan quality of PTV-based intensity modulated proton radiotherapy (IMPT) and volumetric-modulated arc therapy (VMAT) plans for prostate cancer, so as to provide a reference for clinical application. Methods: A total of 10 prostate cancer cases were included in this retrospective study. IMPT and RapidArc plans were designed by RayStation and Eclipse TPS based on PTV, respectively. For each case, IMPT plans were generated using multiple field optimization (MFO) technique with two parallel-opposed lateral fields, whereas RapidArc plans were generated using double-arc technique (two full arcs). Final dose calculation of IMPT was conducted by pencil beam(PB) and Monte Carlo (MC) algorithm, respectively, with adopted data model from the pencil beam scanning (PBS) proton therapy system of IBA Protues Plus(IBA Group, Belgium); The data model originated from the linear accelerator of Varian Clinac iX (Varian Medical Systems, America) was used for RapidArc plans. Dosimetric parameters of DVH and dose distribution were used to compare the dose differences in targets and organs at risk (OARs) between these two treatment techniques. Results: For targets, HIs of PB-IMPT and MC-IMPT were slightly better than that of RapidArc , but CI of IMPT was slightly lower than that of RapidArc; D_1% of PB-IMPT was significantly better than those of MC-IMPT and RapidArc (Z=-2.805, -2.803, P<0.05). PB-IMPT and MC-IMPT achieved better protection than RapidArc on rectum V₃₀(Z=-2.191, -1.988, P<0.05)and D_mean(Z=-2.599, -2.497, P<0.05), bladder V₃₀(Z=-2.701, -2.701, P<0.05), V₄₀(Z=-2.395, -2.395, P<0.05)and D_mean(Z=-2.701, -2.701, P<0.05). There was no significant difference between PB-IMPT and MC-IMPT plans for prostate cancer, except for the D_1% [(73.86±67.34) Gy vs.(75.45±2.01) Gy] (RBE) and HI [(0.040±0.010) vs. (0.058±0.020)] of the target. Conclusions Both techniques can meet the clinical requirements, but IMPT showed significant dosimetric advantages compared with RapidArch by reducing the dose to OARs and improving the plan quality.

Objective To compare the short-term and long-term outcomes between laparoscopic and open total proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC).Methods The retrospective cohort study was conducted.The clinical data of 150 UC patients who underwent total proctocolectomy with IPAA in the Renji Hospital of Shanghai Jiaotong University between January 2003 and December 2016 were collected.Among 150 patients,87 undergoing laparoscopic total proctocolectomy with IPAA and 63 undergoing open total proctocolectomy with IPAA were respectively allocated into the laparoscopy group and open group.Observation indicators:(1) comparisons of intra-and post-operative situations;(2) postoperative complications;(3) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect postoperative recovery and complications up to December 2017.Measurement data with normal distribution were represented as x-±s and comparison between groups was analyzed using the t test.Comparison between groups of count data was analyzed using the chi-square test.Results (1) Comparisons of intra-and post-operative situations:operation time,volume of intraoperative blood loss,time of initial intestinal stoma exsufflation and duration of hospital stay were respectively (306±3) minutes,(197± 12) mL,(62.1±1.8) hours,(8.2±0.4) days in the laparoscopy group and (224±4) minutes,(308±24) mL,(75.6±2.0) hours,(10.1±0.6) days in the open group,with statistically significant difference between groups (t =16.23,4.33,5.03,2.61,P＜ 0.05).All patients discharged successfully from hospital.All the 150 patients underwent stoma reversion of ileum at 3-12 months postoperatively,and the average time in the laparoscopy group and open group was respectively (6.0±5.6) months and (6.0±4.6)months,with no statistically significant difference between groups (t =0.01,P＞ 0.05).(2) Postoperative complications:cases with postoperative wound infection,retention of urine and frequency of defecation ＞ 4 times / day were respectively 2,8,21 in the laparoscopy group and 8,15,29 in the open group,with statistically significant differences between groups (x2 =5.25,4.37,0.96,P＜0.05).The cases with postoperative intestinal obstruction,anastomotic leakage,pelvic infection,pouch infection,pouch-related Crohn's disease and hyperplasia of ileal pouch were respectively 3,10,5,23,2,1 in the laparoscopy group and 8,7,4,24,1,0 in the open group,with no statistically significant differences between groups (x2=3.65,0.11,0.01,0.96,0.17,0.82,P＞0.05).Patients with postoperative complications were improved by acid suppression,fasting,anti-infection and fluid infusion.(3) Follow-up situation:150 patients were followed up for 12-60 months,with a median time of 48 months.There was no abnormality of postoperative anastomotic stoma and intestinal mucosa through comparison of colonoscopy results between pre-operation and 5 year postoperatively.During the follow-up,50 patients had shapeless stool and irregular defecation (times ＞ 4 times / day) at 3 years after stoma reversion of small intestine bypass,including 21 in the laparoscopy group and 29 in the open group,with a statistically significant differences between groups (x2 =4.72,P＜0.05).Eleven and 10 patients in the laparoscopy group and open group had shapeless stool and irregular defecation at 5 years postoperatively,but status were improved compared with the preoperative status,with no statistically significant difference between groups (x2=0.32,P ＞ 0.05).Conclusion The security of laparoscopic total proctocolectomy with IPAA for UC is equivalent to that of open total proctocolectomy,with the better short-term and long-term outcomes.