BACKGROUND: Oxidative injury due to increased intracellular peroxides leads to more frequent onset of epileptic seizure, and the consumption of peroxides through oxidation-reduction played an important role in protection of the central nervous system neurons.OBJECTIVE: To analyze the changes of antioxidants in plasma and erythrocyte of patients with epilepsy.DESIGN: Nonrandomized, paralleled, concurrent controlled study.SETTING: Department of laboratory, psychology, and pharmacy in a university hospital.PARTICIPANTS: Totally 32 epileptic patients were diagnosed in the Department of Neurology, Xiangya Second Hospital, Central South University between March and December 2000 according to the diagnostic and classification criteria of International League Against Epilepsy. The patients consisted of 17 male and 15 female subjects aged from 27 to 59 years, all of whom denied previous anti-epileptic drug exposure(epileptic group) . Another 26concurrent epileptic patients, including 16 male and 10 female subjects aged from 24 to 58 years, confirmed according to the same criteria and treated at the Department of Neurology were also recruited in this study, who reported a history of anti-epileptic therapy with phenobarbiturals for more than one year without acute onset of epileptic seizures during this period(treatment group) .Totally 39 normal controls including 23 male and 16 female subjects were enrolled from those receiving routine health examinations with normal physical indexes. Informed consent was obtained from all these participants.METHODS: Fasting venous blood(2 mL) were collected from each subject at 8:00 - 9:00 am. Enzyme-coupled continuous monitoring was employed to determine the activity of erythrocyte glutathione reductase (EGR), glutathione peroxidase ( GSH-Px ), and catalase (CAT). Pyrogallol autoxidation colorimetry was used to determine the activity of erythrocyte superoxide dismutase(SOD) .The level of erythrocyte malonaldehyde(MDA) was examined with improved TBA colorimetry. Meanwhile hemoglobin(HB) concentration and osmotic fragility of incubated erythrocytes(expressed as the hemolytic percentage)were examined. Plasma vitamin A, C, and E were also determined with high-performance liquid chromatography. Plasna ceruloplasmin(CER) was examined with immunodiffusion assay.MAIN OUTCOME MEASURES: The activity of EGR, GSH-Px, SOD,CAT, content of MDA, erythrocyte hemolytic percentage and the levels of CER and vitamin A, C, E.RESULTS: Only one patient failed to complete the treatment. Erythrocyte MDA content, hemolytic percentage, activity of GSH-Px, and CAT, and CER in epileptic group [ ( 176. 5 ± 12.0) μmol/L, (3.32 ± 0.95 )%, ( 1 503.6±130.0) nkat/g, (75.3±14.6) K/g, (487.0±25.4) mg/L] and treatment group[(129.5±7.4) μmol/L, (1.52±0.20)%, (1 323.6± 95.0) nkat/g, (64.2 ± 10. 1) K/g, (345.0 ± 15.2) mg/L] were significantly higher than those in the control group( t = 2.46 -3.89, P ＜ 0.05 ], but the activity of erythrocyte GR and SOD and the content of plasma vitamin A, E,C[(101.7 ± 13.3) nkat/g, (20.2 ±0. 8) μkat/g, (1. 18 ±0. 83) μmol/L,(20.7 ±4. 5) μmol/L, (20. 6 ±3.6) μmol/L, and(213.4 ±45.0) nkat/g,(28.5 ±0. 9) μkat/g, (3. 14 ±0. 30) μmol/L, (40. 5 ±6.6) μmol/L,(38. 1 ±5.1) μmol/L] were significantly lower than those in the control group ( t = 2.46 - 2.97, P ＜ 0. 05). The activity of GR and SOD and plasma vitamin A, C content of normal control group were significantly higher than those in the epileptic group [(161.7±25.0) nkat/g, (26.7±0.9) μkat/g, (2.09±0. 35) μmol/L, (26.2 ±4. 1) μmol/L, t =2.46 -2.66, P ＜0.05].CONCLUSION: The decrement of intracellular GSH-Px and SOD, and plasma levels of vitamin A, C, E, and CER in epileptic patients can be indicative of the activity of the free radicals during the onset of epileptic seizures.

The method of preparation of a Milk Substitute, formula 5410, and its nutritive value on rats have been reported in previous communications. Further tests of its nutritive effect were made by feeding a group of 100 infants including 4 premature and 10 undernourished. Another group of 43 infants fed with human breast milk or cow's milk were observed during the same period as controls. Among the infants of the two groups there were 6 pairs of twins; one of each pair was fed with the Milk Substitute and the other with human or cow's milk. Great majority of the infants were cared by their own mothers whose cooperation had been secured, while the rest of the infants (10%) were kept in our nursery.The Milk Substitute feeding was started with infants between half and six months of age, with an average age of three months. Observations were continued until they all reached one year old. Fish liver oil and ascorbic acid were supplied to infants of both the experimental and the control groups. Vegetable soup and fruit juice were given to the infants before five months of age. Then various kinds of other foods, including rice porridge, wheat flour nudols, bread, crackers, mashed meat and vegetable and egg yolk were individually supplemented furnishing not more than 1/3 of the total caloric intake, (at the age of one year), as the family income permitted.The appetite of the experimental infants was normal. There was no digestive disturbances and abnormal frequency and appearance of the stool. The average daily caloric intake was similar to those recorded in the literature.The body weight and height of the babies in the experimental group fell well within the normal range. The average initial body weight and height of the infants in the experimental group were somewhat lower than those of the control; however, the height reached .that of the control at the age of 7 months, and the weight at about 11 months. The red blood cell counts and the hemoglobin value of the blood were normal.Values of blood alkaline phosphatase activity higher than 15 Bodansky units were shown in 20 babies of the experimental group (27%) and 8 babies of the control group (23%) at the beginning of the observation; only 4 babies in the experimental group were found abnormal high blood alkaline phosphatase value at the end. At the beginning, 3 cases of rickets and 3 cases of suspected rickets were indicated by the radiograph of the wrist bones of the babies in the experimental group, and only one suspected ricket in the control group were observed; and they all became normal at the end of the experiment. Besides, there were no other signs of any nutritional deficiency among all the infants.

Objective To explore the clinical application of 3D-printing model in guiding interventional management of Budd-Chiari syndrome (BCS) and in teaching practice.Methods A patient with typical BCS of inferior vena cava type was selected.By using MR enhanced scanning,the original MRA data of DICOM format were extracted,and then the digital data were extracted and reconstructed to obtain 3D BCS model by Simpleware software.The 3D BCS entity model,using 1 ∶ 1 ratio,was printed out by a 3D printer.An experienced chief physician made a simulated interventional manipulation on this 3D BCS entity model.Results The BCS 3D model was successfully printed.Simulated operation could be easily performed on the 3D-printing model,in this way the chief physician could make a demonstration of interventional procedure of BCS to the junior doctors and medical students.Interventional therapeutic manipulation for BCS could be well demonstrated on the 3D-printing model of BCS,which was very helpful in guiding teaching practice and in promoting the communication between doctors and patients.Conclusion The BCS 3D-printing model can truly reflect the spatial architecture features of the inferior vena cava and the hepatic veins,which are very valuable for the making of surgical plan,for the demonstration of simulation operation,and for teaching practice.Moreover,3D-printing model can stereoscopically display the location and morphology of the lesion,which can improve patient's understanding of the disease,thus,the communication between doctors and patients can be strengthened.

Objective To investigate the benefits of replanning after induction chemotherapy(IC) by analyzing the dosimetric impact of IC on intensity-modulated radiotherapy(IMRT)for locally advanced nasopharyngeal carcinoma(NPC)and the dosimetric characteristics of replanning after IC, and to provide data for the rational design of clinical radiotherapy plans. Methods 16 NPC patients underwent contrast-enhanced CT scan once before and after IC.Target volumes were delineated and the chemotherapy plans were created,defined as Plan-1 and Plan-2,respectively. Then the target structure after IC was copied to Plan-1, generating the third plan, defined as Plan-1-2. The paired t-test was used to compare the dosimetric parameters between Plan-1 and Plan-1-2 and between Plan-2 and Plan-1-2. Results Plan-1 vs. Plan-1-2:Plan-1-2 showed significantly reduced D meanof target volume compared with Plan-1(P<0.05). Plan-1-2 significantly increased D meanand D maxof the spinal cord(P<0.05),although significantly reduced D mean of the brain stem and D maxof the temporal lobes compared with Plan-1. Plan-1-2 also had significantly reduced conformity index(CI)and significantly increased homogeneity index(HI)for the target volume compared with Plan-1(P<0.05). Plan-2 vs. Plan-1-2:Compared with Plan-1-2, Plan-2 significantly increased D meanand D minof gross tumor volume(GTV)and primary GTV(P<0.05)and significantly reduced D meanof the temporal lobes and D maxand D meanof the spinal cord(P<0.05), with D max decreased to 430.48 cGy;Plan-2 had significantly increased CI and significantly reduced HI for the target volume compared with Plan-1-2(all P<0.05). Conclusions IMRT plan-1 after IC has worse dosimetric distribution,while replanning after IC has more dosimetric benefits.

Objective:To establish a correlation model between MRI and CT images to generate synthetic-CT (sCT) of head and neck cancer during MRI-guided radiotherapy by using generative adversarial networks (GAN).Methods:Images and IMRT plans of 45 patients with nasopharyngeal carcinoma were collected before treatment. Firstly, the MRI (T1) and CT images were preprocessed, including rigid registration, clipping, background removal and data enhancement, etc. Secondly, the cases were trained by GAN, of which 30 cases were randomly selected and put into the network as training set images for modeling and learning, and the other 15 cases were used for testing. The image quality of predicted sCT and real CT were statistically compared, and the dose distribution recalculated upon predicted sCT was statistically compared with that of real planned dose distribution.Results:The mean absolute error of the predicted sCT of the testing set was (79.15±11.37) HU, and the SSIM value was 0.83±0.03. The MAE values of dose distribution difference at different regional levels were less than 1% compared to the prescription dose. The gamma passing rate of the sCT dose distribution was higher than 92% and 98% under the 2mm/2% and 3mm/3% criteria.Conclusions:We have successfully proposed and realized the generation of sCT for head and neck cancer using GAN, which lays a foundation for the implementation of MRI-guided radiotherapy. The comparison of image quality and dosimetry shows the feasibility and accuracy of this method.

Objective:To compare the accuracy and generalized robustness of three predictive models of knowledge-based treatment strategies for radiotherapy for optimized model selection.Methods:The clinical radiotherapy plans of 45 prostate cancer (PC) cases and 25 nasopharyngeal cancer (NPC) cases were collected, and analyzed using three models (Z, L and S model), proposed by Zhu et al, Appenzoller et al and Shiraishi et al, respectively, to predict the dose-volume histogram (DVH) of bladder and rectum on PC cases and that of left and right parotid on NPC cases. The prediction error was measured by the difference of area under the predicted DVH and the clinical DVH curves (|V (pre_DVH)-V (clin_DVH)|), where a smaller prediction error implies a greater prediction accuracy. The accuracies of these three models were compared on the single organ at risk (OAR), and the generalized robustness of models was evaluated and compared by calculating the standard deviation of the prediction accuracy on different OAR. Results:For bladder and rectum, the prediction error of L model (0.114 and 0.163, respectively) was significantly higher than those values of Z and S models (≤0.071, P<0.05); for left parotid gland, the predicted error of S model (0.033) did not present significant difference from those values of Z and L models (≤0.025, P>0.05); for right parotid gland, S model (0.033) demonstrated significantly higher prediction error than those of Z and L models (≤0.028, P<0.05). Regarding different OAR, S model showed a lower standard deviation of prediction accuracy when comparing to Z and L models (0.016, 0.018 and 0.060, respectively). Conclusions:In the prediction of DVH in bladder and rectum of PC, Z and S models were more accurate than L model. In contrast, Z and L models demonstrated higher accuracy than S model in the prediction of left and right parotid glands of NPC. In respect to different OAR, the generalized robustness of S model was superior than the other two models.

Objective To propose a treatment planning optimization algorithm which can make full use of OAR dose distribution prediction meanwhile improving the output planning quality as much as possible.Methods We had reformulated an FMO function under the guidance of dose distribution prediction and also integrated equivalent uniform dose (gEUD) based on the consideration of prediction uncertainty,for providing optimal solution.Performance of the method was evaluated by comparing the optimized IMRT plan quality of 8 cervical cancers in the term of DVH curves,dose distribution and dosimetric endpoints with the original ones.Results The proposed method had a feasible,fast solution.Compared with original plan,its output plan had better plan quality in better dose homogeneity,less hot spot and further dose sparing for OARs.V30,V45 of rectum was decreased by (6.60±3.53)％ and (17.03±7.44)％,respectively,with the statistically significant difference (t=-4.954,-6.055,P＜0.05).V30,V45 of bladder was decreased by (14.74 ± 5.61) ％ and (14.99 ± 4.53) ％,respectively,with the statistically significant difference (t=-6.945,-8.759,P＜0.05).Conclusions We have successfully developed a predicted dose distribution and equivalent uniform dose-based planning optimization method,which is able to make good use of 3D dose prediction and ensure the output plan quality for intensity modulated radiation therapy.

Objective To establish a three-dimensional (3D) dose prediction model,which can predict multiple organs simultaneously in a single model and automatically learn the effect of the geometric anatomical structure on dose distribution.Methods Clinical radiotherapy plans of patients diagnosed with the same type of tumors were collected and retrospectively analyzed.For every plan,each organs at risk (OAR) voxel was regarded as the study sample and its deposited dose was considered as the dosimetric feature.A regularized multi-task learning method than could learn the relationship among different tasks was employed to establish the relationship matrix among tasks and the correlation between geometric structure and dose distribution among organs.In this experiment,the spinal cord,brainstem and bilateral parotids involved in the intensity-modulated radiotherapy (IMRT) plan of 15 nasopharyngeal cancer patients were utilized to establish the multi-organ prediction model.The relative percentage error between the predicted dose of voxel and the clinical planning dose was calculated to assess the feasibility of the model.Results Ten cases receiving IMRT plans were utilized as the training data,and the remaining five cases were used as the test data.The test results demonstrated a higher prediction accuracy and less data demand.And the average voxel dose errors among the spinal cord,brainstem and the left and right parotids were (2.01±0.02)％,(2.65± 0.02) ％,(2.45± 0.02) ％ and (2.55± 0.02) ％,respectively.Conclusion The proposed model can accurately predict the dose of multiple organs in a single model and avoid the establishment of multiple single-organ prediction models,laying a solid foundation for patient-specific plan quality control and knowledge-based treatment planning.

Objective:To investigate the clinical efficacy of redo rectal resection and coloanal anastomosis.Methods:The retrospective and descriptive study was conducted. The clinicopatholo-gical data of 49 patients who underwent redo rectal resection and coloanal anastomosis for the treatment of local recurrence of tumors and failure of colorectal or coloanal anastomosis after rectal resection in the Sixth Affiliated Hospital of Sun Yat-sen University from November 2012 to December 2021 were collected. There were 32 males and 17 females, aged 57(range,31-87)years. Redo rectal resection and coloanal anastomosis was performed according to the patient′s situations. Observa-tion indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distri-bution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers or percentages. Results:(1) Surgical situations. All 49 patients underwent redo rectal resection and coloanal anastomosis successfully, with the interval between the initial surgery and the reopera-tion as 14.2(7.1,24.3)months. The operation time and volume of intraoperative bold loss of 49 patients in the redo rectal resection and coloanal anastomosis was 313(251,398)minutes and 125(50,400)mL, respectively. Of the 49 patients, there were 38 cases receiving laparoscopic surgery including 12 cases with transanoscopic laparoscopic assisted surgery, 11 cases receiving open surgery including 2 cases as conversion to open surgery, there were 20 cases undergoing Bacon surgery, 14 cases undergoing Dixon surgery, 12 cases undergoing Parks surgery, 2 cases undergoing intersphincter resection and 1 case undergoing Kraske surgery, there were 20 cases undergoing rectum dragging out excision and secondary colonic anastomosis, 13 cases undergoing dragging out excision single anastomosis, 12 cases undergoing rectum dragging out excision double anastomosis, 4 cases undergoing first-stage manual anastomosis, there were 21 cases with enterostomy before surgery, 16 cases with prophylactic enterostomy after surgery, 12 cases without prophylactic enterostomy after surgery. The duration of postoperative hospital stay of 49 patients was (14±7)days. (2) Postoperative situations. Fifteen of 49 patients underwent postoperative complications, including 8 cases with grade Ⅱ Clevien-Dindo complications and 7 cases with ≥grade Ⅲ Clevien-Dindo complications. None of 49 patient underwent postoperative transferring to intensive care unit and no patient died during hospitalization. Results of postoperative histopathological examination in 23 patients with tumor local recurrence showed negative incision margin of the surgical specimen. (3) Follow-up. All 49 patients underwent post-operative follow-up of 90 days. There were 42 cases undergoing redo rectal resection and coloanal anastomosis successfully and 7 cases failed. Of the 37 patients with enterostomy, 20 cases failed in closing fistula, and 17 cases succeed. There were 46 patients receiving follow-up with the median time as 16.1(7.5,34.6)months. The questionnaire response rate for low anterior resection syndrome (LARS) score was 48.3%(14/29). Of the patients who underwent redo coloanal anastomosis and closure of stoma successfully, there were 9 cases with mild-to-moderate LARS.Conclusion:Redo rectal resection and coloanal anastomosis is safe and feasible for patients undergoing local recurr-ence of tumors and failure of colorectal or coloanal anastomosis after rectal resection, which can successfully restore intestinal continuity in patients and avoid permanent enterostomy.

ObjectiveTo predict whether antiviral therapy is required in patients with chronic hepatitis B virus （HBV） infection and an age of ≤30 years by establishing a noninvasive model， and to investigate the diagnostic value of this model. MethodsA retrospective analysis was performed for the clinical data of 175 patients with chronic HBV infection who were admitted to Shenzhen Third People’s Hospital from January 2017 to January 2023 and met the inclusion criteria， and according to the results of liver biopsy， they were divided into treatment group with 41 patients （with indications for antiviral therapy） and observation group with 134 patients （without indications for antiviral therapy）. The two groups were analyzed in terms of the indicators including clinical data， imaging examinations， and serum biochemical parameters. The univariate and multivariate Logistic regression analyses were used to investigate the parameters affecting the indication for antiviral therapy， and different models for predicting the need for antiviral therapy were constructed based on related parameters. The receiver operating characteristic （ROC） curve was used to compare the diagnostic value of different models. The independent-samples t test was used for comparison of normally distributed continuous variables between groups， and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous variables between groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. ResultsThere were significant differences between the treatment group and the observation group in alanine aminotransferase， ferritin， total cholesterol （CHOL）， triglyceride， platelet count， liver stiffness measured by sound touch elastography （STE）， and procollagen III N-terminal propeptide （PIIIP） （all P<0.05）. The multivariate Logistic regression analysis showed that CHOL （odds ratio ［OR］=0.4， 95% confidence interval ［CI］： 0.2‍ ‍—‍ ‍1.0）， STE （OR=1.5， 95%CI： 1.0‍ ‍—‍ ‍2.1）， and PIIIP （OR=1.1， 95%CI： 1.0‍ ‍—‍ ‍1.1） were independent predictive factors for the indications for antiviral therapy. Model 1 （STE+PIIIP+CHOL）， model 2 （STE+PIIIP）， model 3 （STE+CHOL）， model 4 （PIIIP+CHOL） had an area under the ROC curve of 0.908， 0.848， 0.725， and 0.725， respectively， while STE， PIIIP， and CHOL used alone had an AUC of 0.836， 0.725， and 0.634， respectively， suggesting that model 1 had the largest AUC， with a specificity of 77.34% and a sensitivity of 96.36%， and had a significant difference compared with STE， PIIIP， CHOL， and the models 2， 3， and 4 （Z=0.21， 3.08， 3.06， 3.23， 0.89， and 0.88， all P<0.05）. ConclusionThe noninvasive model established based on CHOL， STE， and PIIIP has a good value in predicting the need for antiviral therapy in patients with chronic HBV infection and an age of ≤30 years.