At present, the pathophysiological mechanisms of progressive stroke remain unclear. It is difficult to accurately predict which patients will have deterioration of neurological function. 1he factors of blood pressure, C-reactive protein concentration, cerebral artery stenosis, hyperglycemia, and infarct location in early stroke are closely associated with progressive stroke. It has some predictive values for its occurrence.

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 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 evaluate the clinical effect of uterine arterial embolization (UAE) as a treatment of symptomatic uterine fibroids(UF).Methods Twenty-six patients with clinic symptoms(menorrhagia, pelvic pain, bulk-related symptoms and anemia)caused by uterine fibroids underwent UAE.The embolization with a single catheter using the single-femoral artery approach to bilateral uterine artery was performed, injection of PVA 355～500 ?m and silk particles were used in 20 and 6 cases respectively.Results All cases were followed up for 6 to 18 months after treatment.The symptoma were noticeable improvement in 24 cases but 2 cases whom with injection silk particles.The tumors were marked diminution in size(45%～75%) sonographically after 2～6 months in 13 cases.No severe complication were discovered in all cases.Conclusion Uterine artery embolization is a safe and effective method for the management of symptomatic UF.Longer follow up is needed to evaluate the long term effects.

Objective: To investigate the epidemiological characteristics of malaria in Hangzhou City from 2004 to 2021, so as to provide the evidence for formulating the post-elimination control strategy for malaria in Hangzhou City. Methods: The epidemic situation of malaria in Hangzhou City from 2004 to 2021 were collected from the National Information System for Disease Control and Prevention in China, and the temporal, spatial and human distributions of malaria cases and the source of malaria infections were analyzed in Hangzhou City during the pre-elimination stage (2004 to 2009), the elimination stage (2010 to 2015) and the post-elimination stage (2016 to 2021). Results: Totally 602 malaria cases were reported in Hangzhou City from 2004 to 2021,and the annual mean incidence of malaria was 0.22/105, 0.20/105 and 0.18/105 during the pre-elimination, elimination and post-elimination stages, appearing a tendency towards a decline. Men accounted for 63.96%, 85.07% and 93.75% of all malaria cases and there were 67.86%, 82.84% and 80.00% of cases at ages of 18 to 50 years during the pre-elimination, elimination and post-elimination stages, both appearing a tendency towards a decline (χ2trend=56.748, P<0.001; χ2trend=39.971, P<0.001). The predominant occupation of malaria cases shifted from farmers or migrant workers to multiple occupations, and the proportion of commercial servants increased from 4.87% during the pre-elimination stage to 24.38% during the post-elimination stage (χ2trend=73.308, P<0.001). The proportion of Plasmodium vivax malaria cases reduced from 96.43% during the pre-elimination stage to 7.50% during the post-elimination stage, and the proportion of P. falciparum malaria cases increased from 3.57% to 71.25%, while P. ovale, P. malariae and mixed infections were identified since 2010. There was a significant season-specific incidence of P. vivax malaria during the pre-elimination stage, and the period between May and October was an epidemic season; however, there was no season-specific incidence of P. vivax malaria during the elimination and post-elimination stages. The regional distribution of malaria cases presented a tendency towards a shift from suburb and rural areas to urban areas (χ2trend=74.229, P<0.001). No local cases were detected in Hangzhou City since 2010, and 94.22% of malaria cases were overseas imported cases after malaria elimination, including 90.61% from Africa. Conclusions oung and middle-aged men were high-risk populations for malaria in Hangzhou City from 2004 to 2021, and overseas commercial servants gradually became the predominant source of malaria infections, with malaria parasite species tending to be diverse. Improving the management of overseas imported cases and timely identification and treatment of cases are major interventions to consolidate malaria elimination achievements in Hangzhou City.

Purpose: Temozolomide is used in first-line treatment for glioblastoma. However, chemoresistance to temozolomide is common in glioma patients. In addition, mechanisms for the anti-tumor effects of temozolomide are largely unknown. Ferroptosis is a form of programmed cell death triggered by disturbed redox homeostasis, overloaded iron, and increased lipid peroxidation. The present study was performed to elucidate the involvement of ferroptosis in the anti-tumor mechanisms of temozolomide. Materials and Methods: We utilized the CCK8 assay to evaluate cytotoxicity. Levels of lactate dehydrogenase (LDH), malondialdehyde (MDA), iron, and glutathione (GSH) were measured. Flow cytometry and fluorescence microscope were used to detect the production of reactive oxygen species (ROS). Western blotting, RT-PCR and siRNA transfection were used to investigate molecular mechanisms. Results: Temozolomide increased the levels of LDH, MDA, and iron and reduced GSH levels in TG905 cells. Furthermore, we found that ROS levels and DMT1 expression were elevated in TG905 cells treated with temozolomide and were accompanied by a decrease in the expression of glutathione peroxidase 4, indicating an iron-dependent cell death, ferroptosis. Our results also showed that temozolomide-induced ferroptosis is associated with regulation of the Nrf2/HO-1 pathway. Conversely, DMT1 knockdown by siRNA evidently blocked temozolomide-induced ferroptosis in TG905 cells. Conclusion Taken together, our findings indicate that temozolomide may suppress cell growth partly by inducing ferroptosis by targeting DMT1 expression in glioblastoma cells.

Purpose: Temozolomide is used in first-line treatment for glioblastoma. However, chemoresistance to temozolomide is common in glioma patients. In addition, mechanisms for the anti-tumor effects of temozolomide are largely unknown. Ferroptosis is a form of programmed cell death triggered by disturbed redox homeostasis, overloaded iron, and increased lipid peroxidation. The present study was performed to elucidate the involvement of ferroptosis in the anti-tumor mechanisms of temozolomide. Materials and Methods: We utilized the CCK8 assay to evaluate cytotoxicity. Levels of lactate dehydrogenase (LDH), malondialdehyde (MDA), iron, and glutathione (GSH) were measured. Flow cytometry and fluorescence microscope were used to detect the production of reactive oxygen species (ROS). Western blotting, RT-PCR and siRNA transfection were used to investigate molecular mechanisms. Results: Temozolomide increased the levels of LDH, MDA, and iron and reduced GSH levels in TG905 cells. Furthermore, we found that ROS levels and DMT1 expression were elevated in TG905 cells treated with temozolomide and were accompanied by a decrease in the expression of glutathione peroxidase 4, indicating an iron-dependent cell death, ferroptosis. Our results also showed that temozolomide-induced ferroptosis is associated with regulation of the Nrf2/HO-1 pathway. Conversely, DMT1 knockdown by siRNA evidently blocked temozolomide-induced ferroptosis in TG905 cells. Conclusion Taken together, our findings indicate that temozolomide may suppress cell growth partly by inducing ferroptosis by targeting DMT1 expression in glioblastoma cells.

Objective Dual-source CT(DSCT) energy imaging was used to analyze the difference of energy spectrum pa-rameters and energy spectrum curves between mediastinal metastatic lymph nodes and non-metastatic lymph nodes in non-small cell lung cancer(NSCLC). The relationship between DSCT standardized iodine concentration and energy spectrum curve with medias-tinal lymph node metastasis was discussed. Methods A total of 113 patients with NSCLC underwent DSCT energy imaging scans. Io-dine images were obtained at the processing workstation. The normalized iodine concentrations of all mediastinal lymph nodes and en-ergy spectrum curves at different energy levels were measured. According to the pathological results,the patients were divided into lymph node metastasis group and non-lymph node metastasis group. The normalized iodine concentration and energy spectrum curve slope of the two groups were analyzed by t-test. The best threshold of standardized working iodine concentration was calculated by re-ceiver operating characteristic curve(ROC)to diagnose the mediastinal lymph node metastasis of NSCLC. Results There was a sig-nificant difference in the normalized iodine concentration between the two groups of mediastinal lymph nodes in NSCLC(P<0. 05);The ROC curve was used to calculate the standardized iodine concentration for the diagnosis of NSCLC. The optimal threshold for lymph node metastasis was 52. 45% ;The energy spectrum curve of mediastinal lymph nodes in NSCLC was gradually decreasing. There was a significant difference between the two groups in the range of 40~110 keV interval(P<0. 05). Conclusion The quanti-tative analysis of DSCT energy imaging parameters is of great significance in the diagnosis of mediastinal lymph node metastasis in NSCLC. It can be used as an important index for preoperative judgment of lymph node metastasis in NSCLC.

Objective:Diabetic retinopathy (DR) has been reported as the leading cause of blindness among diabetic adults, which is closely related to poor quality of life and increased burden of disability. This study aimed to aggregate the optimally available evidence on modifiable risks of DR.Methods:Until June 2023, PubMed, Cochrane Library, CNKI, and Wanfang databases were used to retrieve Meta-analysis about various risk factors for DR, and Meta-analysis were analyzed and summarized. R 4.3.2 software was used for each Meta-analytic association to calculate the effect size, 95% CI, heterogeneity, small-study effects, excess significance bias, and 95% prediction intervals. The credibility of significant evidence was graded. Results:We captured 23 eligible papers (72 associations) covering a wide range of medication use, concomitant diseases, daily intervention, biomarkers, lifestyle, and physical measurement index. Among them, higher HbA1c variability ( RR=1.45, 95% CI: 1.26-1.66) and urine microalbumin positive ( OR=2.44, 95% CI: 1.99-2.97) were convincing (grade Ⅰ) evidence, and insulin use ( RR=3.48, 95% CI: 2.14-5.67) was highly suggestive (grade Ⅱ) evidence. Moreover, hypertension ( OR=2.03, 95% CI: 1.06-3.97), poor glycemic control ( OR=4.35, 95% CI: 1.47-12.85), positive macroalbuminuria ( OR=8.42, 95% CI: 3.52-20.15), long sleep duration ( OR=2.05, 95% CI: 1.37-3.05), vitamin D deficiency ( OR=2.02, 95% CI: 1.17-3.50), periodontitis ( OR=4.51, 95% CI: 1.76-11.55) were the main risk factors for DR. Intensive blood pressure intervention ( RR=0.78, 95% CI: 0.65-0.94), dietary control ( OR=0.64, 95% CI: 0.47-0.89) and moderate intensity physical activity ( RR=0.76, 95% CI: 0.59-0.97) yielded significant protective associations with DR. Conclusions:Intensive blood pressure glycemic control, and a healthy lifestyle pattern could reduce the risk of DR. This study provides the evidence to identify high-risk populations and recommends rational treatment options and healthy living interventions.

Objective:To learn about the knowledge and practice of iodine deficiency disorders (IDD) prevention and control among main caregivers of pregnant women in trimester and its related influencing factors, so as to provide a scientific basis for effectively improving the iodine nutrition level of pregnant women.Methods:In April 2020, using the stratified sampling method, 2 districts and counties were selected in the urban, suburban and rural areas of Hangzhou City, respectively, and 5 maternal and child health care institutions were selected as the survey sites in each district and county according to the five directions of East, West, South, North and Middle. A face-to-face questionnaire investigation was used to investigate the knowledge and practice of IDD prevention and control among main caregivers of pregnant women.Results:Totally 601 caregivers of pregnant women were investigated. Among them, 68.9% (414/601) knew that eating iodized salt was the best way to prevent IDD. However, 15.0% (90/601) thought that eating seafood was the best way to prevent IDD. And 41.9% (252/601) caregivers of pregnant women would actively purchase iodine-rich food for cooking, and 63.6% (382/601) would choose iodized salt. There were statistically significant differences in the knowledge and practice of IDD prevention and control among caregivers of pregnant women in urban, suburban and rural areas ( P < 0.05). And 50.3% (87/173) male caregivers would actively purchase iodine-rich food for cooking, which was higher than that of female caregivers [38.6% (165/428)], the difference was statistically significant (χ 2 = 6.97, P = 0.008). There was a statistically significant difference between the caregivers of pregnant women of different ages in actively purchasing iodine-rich food for cooking (χ 2 = 12.61, P = 0.013). And there were statistically significant differences between the caregivers of pregnant women with different educational levels in actively purchasing iodine-rich food for cooking and choosing iodized salt (χ 2 = 29.34, 39.42, P < 0.001). Conclusions:The awareness of knowledge about IDD prevention and control and the formation of prevention and control behavior among caregivers of pregnant women in Hangzhou City are poor. Active education of caregivers of pregnant women should be strengthened to promote maternal and infant health.