Kidney remodeling is a response to intrinsic or extrinsic triggers of kidney injury.The response potentialy control life-threatening dangers and to regain homeostasis,including tissue repair,inflammation to control the risk of infection,epithelial repair,scar resolution or minimization.Mesangial cell involved in clotting,fibrinolysis,triggering glomerular inflammation and mesangioproliferative disorders.Mesangial cell may play an important role in the devoloping of glomerular diseases and in controlling the risks of these diseases.

Objective To investigate an X-ray total body irradiation (TBI) technique using anterior-posterior opposed fields with patients at the side-lying position,and to analyze the real-time in vivo dosimetry results.Methods The accelerator with 10 MV X-rays of Varian Trilogy was used for the TBI with the extended source to skin distance of 390 cm.The percent depth dose,off axis factors and absolute dose output were measured.The dose accuracy and homogeneity was monitored real-time using multichannel diode dosimeter for 10 patients.The monitored sites included forehead,mandible,suprasternal fossae,xiphoid,umbilicus,pelvis,middle of thigh,knee,middle of leg and ankle.The patients were irradiated at the side-lying position,with the prescription dose of 1 200 cGy/6 f during 3 days,the middle line dose rate of 5.0 cGy/min.Solid water was used for the compensation of the dose homogeneity.Results The off axis dose homogeneity was less than ± 5.0％ for the TBI geometry.The absolute dose output was 0.072 1 cGy/MU at the maximum dose point.The total body irradiation was finished smoothly for the 10 patients lying on side.The deviation of monitored total dose from the total prescription dose was within -4.9％ to 6.7％ for the 10 monitored sites.The monitored dose homogeneity was less than 5.0％.Conclusions The fractionated anterior-posterior opposed parallel TBI can be finished smoothly with patients side-lying.Accurate and homogenous dose distribution can be obtained using real-time dose monitoring and compensation with solid water.

Objective To analyze the patient-specific dosimetric verification results of 2010 intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans from different treatment sites,and provide a reference for improving the patient-specific dosimetric verification program.Methods A total of 2 010 (965 IMRT and 1 045 VMAT) patient-specific dosimetric verification results were reviewed for isocenter dose difference and percentage of pixels passing planar dose γ analysis.All plans were designed with Eclipse planning system and delivered with Trilogy linear accelerator from February 2012 to February 2016.The dosimetric verification was performed with MatriXX array together with Muhicube phantom.Point dose difference larger than ± 3％ and/or γ pass rate (3％/ 3 mm) less than 90％ was defined as plan failure.Additional analysis was conducted for trends in difference of pass rates with treatment site and delivery technique (IMRT vs.VMAT).Results The mean isocenter difference between measured and calculated doses was-0.3％ ± 2.4％ for 2 010 plans.The mean percentage of pixels passing the γ criteria was 97.9％ ± 3.4％.88.2％ and 96.7％ of plans passed the point and planar dose verification,respectively.The γ pass rate was different among the treatment sites (F =3.09,P ＜ 0.05).The pass rate of point and planar dose difference was different among the treatment sites(x2 =40.93,39.15,P ＜0.05).There was no difference between IMRT and VMAT plans for both point dose and planar dose evaluation (P ＞ 0.05).Conclusions Most of IMRT and VMAT plans passed the tolerance criteria of ±3％ and 90％ for point and planar dose verification with MatriXX together with Multicube phantom,respectively.Both point and planar dose verification results varied among treatment sites,whereas no significant difference was found between IMRT and VMAT.

Objective To evaluate the clinical efficacy of dragon-tiger contending needling at Xi-cleft points plus electroacupuncture in treating postherpetic neuralgia (PHN).Method Seventy PHN patients were randomized into a treatment group of 36 cases and a control group of 34 cases. The treatment group was intervened by dragon-tiger contending needling at Xi-cleft points plus electroacupuncture, while the control group was treated with electroacupuncture alone. In the 4-week treatment, the Visual Analogue Scale (VAS) scores right before and after the 1st, 2nd, 6th, 9th and 12th treatment sessions were recorded, “the maximum pain intensity since the last treatment session” and “real-time analgesic effect” were observed, and the total therapeutic efficacy was also evaluated.Result The real-time analgesic effects right after the 1st, 2nd and 6th treatments in the treatment group were significantly better than those in the control group (P<0.05). The “maximum pain intensities since the last treatment session” prior to the 2nd, 6th, 9th, and 12th treatment sessions were significantly different from the pain intensity before the intervention in the two groups (P<0.05). The “maximum pain intensities since the last treatment session” prior to the 6th, 9th, and 12th treatment sessions were significantly different from those in the control group (P<0.05). The total effective rate and recovery plus markedly-effective rate were respectively 97.2% and 77.8% in the treatment group, versus 91.2% and 59.2% in the control group. There was a statistically significant difference in the recovery plus markedly-effective rate between the two groups (P<0.05).Conclusion Dragon-tiger contending needling at Xi-cleft points plus electro- acupuncture is an effective approach in treating PHN; it acts efficiently and can produce a satisfactory real-time analgesic effect.

Objective·To investigate the correlation of single nucleotide polymorphism (SNP) of complement factor H (CFH) gene with schizophrenia in Chinese Han population.Methods·The genotype,allele,and haplotype frequencies of 5 SNP loci (rs800292,rs 1061170,rs 10801555,rs 10922096 and rs2019727) in CFH gene were compared between 418 patients with schizophrenia (case group) and 655 normal people (control group) by SNaPshot technique.Results·All SNP loci were well genotyped in the subjects.Correlation analysis showed that rs1061170 locus allele frequency distribution difference between case group and control group was statistically significant (corrected P=0.045),while genotype and allele frequencies of other SNP loci were not significantly different (all corrected P＞0.05).The frequency of haplotype C-A-T-A-A (rs800292-rs1061170-rs10801555-rs10922096-rs2019727) in case group was different from that in control group (corrected P=0.013).Conclusion·The allele polymorphisms of rsl061170 and the haplotype C-A-T-A-A of rs800292-rs 1061170-rs 10801555-rs 10922096-rs2019727 may be associated with schizophrenia in Chinese Han population.

Objective To compare five different detectors in output factor(OF)measurement for the CyberKnife(CK)system,and to select a suitable detector. Methods OFs for 12 different sizes of CK collimators were measured by EBT3films and 5 different commercially available detectors,consisting of diode detectors PTW 60017 and PTW 60018,ionizing chamber detectors PTW 31010 and PTW 30013,and diamond detector PTW 600019.OF was compared between different detectors and different measurement orientations. Results When the size of collimator was larger than 30 mm,the OF deviation among five detectors was less than 1%.When the size of collimator was smaller than 30 mm,however,the OF deviation among five detectors became large and obviously increased with the decrease in the size of collimator. With a OF deviation less than 2%,PTW 60019 achieved the best agreement with films. Compared with films,diode detectors gave slightly higher OFs,while ionizing chamber detectors gave much smaller OFs. The OF measurement was also affected by measurement orientation. PTW 60019 gave a smaller OF in the direction parallel to the central axis than in the direction perpendicular to the central axis of the radiation field,while PTW 31010 had an opposite result. Conclusions When the size of collimator is larger than 30 mm,PTW 31010,PTW 60017,PTW 60018,and PTW 60019 can be directly used for the OF measurement. When the size of collimator is smaller than 30 mm,correction is needed for the OF measurement using the above detectors. PTW 30013 is not suitable for the OF measurement in the small radiation field.

Objective To evaluate four detectors for the off-axis ratio profile measurements of a CyberKnife system, and provide reference and suggestions for selecting and using the correct detectors. Methods Profiles were acquired by using four detectors, PTW-60017, PTW-60018, PTW-60019 and IBA-SFD, at different depths for different collimator sizes, with the detector stem being oriented both perpendicular and parallel to the central beam axis. The differences of profiles and the influence of detector orientation on measurement result were analyzed. Results All full width at half maximum ( FWHM) of field measured by four detectors in parallel orientation was larger than that in actual field size. The deviation was increased with the size of collimator and measurement depth, with the maximum deviation of 1. 9 mm. The maximum deviation of FWHM among four detectors was 0. 2 mm. The penumbra was the smallest for IBA-SFD, and the largest for PTW-60019. The maximum deviation of penumbra was 0. 3 mm. The IBA-SFD tended to over-respond in the out-of-field region when the collimator size was larger than 30 mm. Both FWHM and penumbra in perpendicular orientation were smaller than those in parallel orientation for PTW-60017, PTW-60018 and PTW-60019, especially at 5 mm collimator. However, the trend was opposite for IBA-SFD. With the increase of collimator aperture, the difference between the right and left penumbra acquired by four detectors was increased, with more obvious stem effects. Conclusions Similar profiles were acquired by four detectors, but the detector characteristics and effects of detector orientations should be considered.

Objective To evaluate the accuracy and reliability of the CyberKnife VSI system for stereotactic radiotherapy.Methods First,the mechanical accuracy of the robotic manipulator system,the repeatability of the Iris variable aperture collimator system,the couch position accuracy of the patient positioning system,the tacking precision of the target locating system and the dosimetric beam characteristics of the linac system for each subsystem of CyberKnife VSI system were tested.Finally,the total beam delivery precision of the CyberKnife VSI system was evaluated.Results The mean positioning deviations of the mechanical arm movement of the robotic manipulator system were less than 0.1 mm,and the maximum positioning deviation of single note was ≤ 0.29 mm.The repeatability of the aperture sizes for the Iris variable aperture collimator system was ≤ 0.28 mm.The couch position accuracy of the patient positioning system was＜0.2 mm and the tracking precision of the target locating system was less than 0.5°.The linac beam-laser beam axes coincidence between the Iris and fixed collimators was better than 0.4 mm.The 6-MV beam parameters,such as beam quality and profile,were found within the acceptance limits.The deviations of output reproducibility,linearity and constancy versus linac orientation were less than 1.0％.The transmission factors of two types of collimators were lower than 0.4％.End-to-end test demonstrated that the maximum deviation of the total delivery precision of CyberKnife VSI system was 0.87 mm.Conclusion The CyberKnife VSI system is accurate and reliable for stereotactic radiotherapy.

Objective To evaluate the prognostic value of preoperative neutrophil-to lymphocyte ratio (NLR) in invasive breast carcinomas of no special type.Methods we retrospectively analyzed the clinical and pathological data of all breast cancer patients at Shanghai Huangpu District Cental Hospital from Jan.2012 to Dec.2012.The optimal cutoff value was obtained by ROC.The difference among variables was calculated by chi-square test.DFS and OS were estimated using Kaplan-Meier method.Cox analysis was performed to analyze clinical parameters for their prognostic relevance.Results A total of 493 were eligible.The optimal cutoff value of NLR was 2.057.The sensitivity was 0.767 and specifity was 0.327 at the optimal cutoff point.Univariate analysis showed that patients with NLR higher than 2.057 had significantly lower DFS (P=-0.001) than patients with NLR equal or lower than 2.057,while the overall survival rate was not statistically different (P=0.131).The Cox proportional multivariate hazard model revealed that higher NLR was independently related with poor DFS with hazard ratio 5.649(95％ confidence interval 3.128-10.201,P=0.002).Conclusions Preoperative NLR is an independent predictor of DFS in breast cancer patients.Further validation and a feasibility study are required before it can be considered for clinical use.

Objective To explore the effect of exercise preconditioning on inflammatory response in ischemic stroke brain tissue which mediated by miR-146a in extracellular vesicles in rats with middle cerebral artery oc-clusion(MCAO),and its mechanism.Methods Sixty 6-week-old male Sprague-Dawley rats were randomly divid-ed into a non-exercise group and an exercise group.The non-exercise group was further divided into a sham-operation control group(C,n=15)and an MCAO model group(M,n=15),while the exercise group was further di-vided into an exercise only group(E,n=15)and an exercise plus MCAO model group(EM,n=15).Rats in the E and EM groups underwent 8 weeks of treadmill exercise,6 days per week,30 minutes per day.Then rats in the M and EM groups received MCAO to induce ischemic stroke,while the C and E groups underwent a sham surgery.Twenty-four hours after the surgery,neurobehavioral tests were performed.Plasma was collected to ex-tract extracellular vesicles,and brain tissue was collected to measure the volume of cerebral infarction by using the triphenyl tetrazolium chloride(TTC)staining.Moreover,the Nissl staining was conducted to observe neuronal and Nissl body.Mean while,the content of miR-146a in plasma extracellular vesicles and brain tissue was mea-sured by using the quantitative polymerase chain reaction(qPCR),and the expression of TNF receptor associat-ed factor 6(TRAF6),nuclear factor kappa-B(NF-κB)and tumor necrosis factor-α(TNF-α)in brain tissues were determined using Western blotting.The targeting relationship between miR-146a and TRAF6 was detected by using the dual luciferase reporter gene assay.Results(1)The neurological behavioral scores of the EM and M groups were higher than those of the C group(P<0.01 and P<0.01),with that of the EM group lower than the M group(P<0.01).(2)TTC staining showed that the infarct volume of the EM and M groups was larger than that of the other two groups(P<0.01 and P<0.01),with that of the EM group smaller than the M group(P<0.01).(3)Nissl staining results showed that the neuronal arrangement was loose,the number of neurons re-duced,and the Nissl bodies were lightly stained and decreased in the M group compared with the C and E groups.Moreover,compared with the M group,the number of neurons and Nissl bodies increased in the EM group.(4)The qPCR analysis showed that the expression of miR-146a in the plasma-derived exosomes and brain tissues of the EM and M groups decreased compared with the C group(P<0.05 and P<0.01),with that of the EM group higher than the M group(P<0.05).(5)According to Western blotting,compared with the C group,the expression levels of TRAF6,NF-κB,and TNF-α proteins increased significantly(P<0.05 and P<0.01),with that of group EM signfiicantly lower than group M(P<0.05 and P<0.05).(6)Dual-luciferase report-er gene assay showed that miR-146a had a specific binding site with TRAF6.Conclusion Eight weeks of exer-cise preconditioning reduces the infarct area and the extent of brain damage,which may be mediated by miR-146a via exosomes,increasing the expression of miR-146a in brain tissue,targeting TRAF6,negatively regulat-ing TRAF6/NF-κB,and reducing the expression of TNF-α,thus alleviating the inflammatory response in brain tissue and exerting a protective effect on ischemic brain injury.