AIM To explore the clinical effects of comprehensive treatment regimen of traditional Chinese medicine on patients with refractory rhinosinusitis.METHODS One hundred and sixty-four patients were randomly assigned into control group(82 cases)for 3-month intervention of comprehensive treatment regimen of western medicine(Physiological Seawater Nasal Spray,Budesonide Nasal Spray,Clarithromycin Tablets),and observation group(82 cases)for 3-month intervention of comprehensive treatment regimen of traditional Chinese medicine(Xinzhi Tongqiao Granules,Xinbai Nasal Fumigation Powder,acupuncture of sphenopalatine ganglion).The changes in clinical effects,subjective disease indices(clinical symptom scores,SNOT-20 score,Lung Meridian Heat Accumulation Syndrome score),objective disease indices(Lund-Kennedy score,T&T olfactory score,MTT,MTR),inflammatory indices(LTC4,IL-17a,IL-33,ECP),immune indices(CD4+,CD8+,Treg,Th17,CD4+/CD8+,Th17/Treg)and safety indices were detected.RESULTS The observation group demonstrated higher total control rate than the control group(P＜0.05).After the treatment and at 3-month follow-up,the two groups displayed decreased clinical symptom scores,inflammatory indices,CD8+,Th17,Th17/Treg,SNOT-20 score,Lung Meridian Heat Accumulation Syndrome score,Lund-Kennedy score,T&T olfactory score(P＜0.05),increased CD4+,Treg,CD4+/CD8+,MTR(P＜0.05),and shortened MTT(P＜0.05),especially for the observation group(P＜0.05).No obvious adverse reactions were observable in the two groups.CONCLUSION For the patients with refractory rhinosinusitis,the comprehensive treatment regimen of traditional Chinese medicine can safely and effectively improve inflammatory responses,immune functions and mucociliary motor functions,repair the status and functions of nasal mucosa,alleviate subjective and objective symptoms,and enhance life quality.

Objective:To observe the effect of hyperthermia combined with paclitaxel on the proliferation, apoptosis and cycle of human tongue squamous cell carcinoma cell line CAL-27, and to explore the underlying mechanism.Methods:The working concentration of paclitaxel was determined by CCK-8 assay, and the cultured CAL-27 cells were divided into the control, paclitaxel, 42℃ hyperthermia and combined treatment groups. The ability of cell proliferation was detected by colony formation assay, and the cell cycle and apoptosis were determined by flow cytometry. The expression levels of AKT, p-AKT, Bcl-2 and Bax proteins in each group were measured by Western blot.Results:Compared with the control group, the proliferation was significantly inhibited and the apoptosis of CAL-27 cells was significantly promoted in the combined treatment, hyperthermia and paclitaxel groups (all P<0.05), and the anti-proliferation and apoptosis-promoting effect in the combined treatment group was significantly better than those in the hyperthermia and paclitaxel groups (all P<0.05). Western blot showed that hyperthermia combined with paclitaxel could significantly up-regulate the expression level of Bax protein and significantly down-regulate the expression levels of P-AKT and Bcl-2 in CAL-27 cells (all P<0.05). Conclusions:Hyperthermia combined with paclitaxel can play a synergistic role in inhibiting proliferation and promoting apoptosis of tongue squamous cell carcinoma CAL-27 cells. The mechanism may be related to the inhibition of AKT activation and the activation of Bax/Bcl-2 apoptosis signaling pathway.

Objective: Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear. Methods: A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio ( Results: Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks. Conclusion Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.
Adult ; Aged ; COVID-19/virology* ; China/epidemiology* ; Comorbidity ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome

Objective To investigate the safety and efficacy of 177Lu-prostate specific membrane antigen (PSMA)-617 in the treatment of metastatic castration-resistant prostate cancer (mCRPC).Methods From August 2017 to September 2018,11 patients(average age 70.6 years) with mCRPC who underwent 177Lu-PSMA-617 therapy in Nanjing First Hospital were studied.All patients underwent 68Ga-PSMA-11 PET/CT before therapy to assess the tumor radioactive uptake.Blood routine examination and renal function test results were documented before and after therapy to assess the safety.The efficacy was reflected by the changes of prostate specific antigen (PSA) levels and maximum standardized uptake value (SUVmax) on 68Ga-PSMA-11 PET/CT imaging.Paired t test and Wilcoxon's sign rank test were used to analyze the data.Results No acute side effects were observed after therapy of 177Lu-PSMA-617.There were no statistically significant differences after therapy in WBC counts,RBC counts,and PLT,as well as Hb levels (t values:-0.28-1.11,all P＞ 0.05).No kidney toxicity was found.The PSA level after 177Lu-PSMA-617 therapy was significantly lower than that before therapy (80.70 (14.29,1 538.00) μg/L vs 604.60 (88.41,3 980.00) μg/L;u =59,P =0.023).Of the 11 patients,only 2 had elevated PSA levels and disease progression,while the other 9 patients had varying decreases,of which 2/11 decreased by ＞30％ and 7/11 decreased by ＞50％.After therapy,SUVmax of metastatic lesions and metastatic lymph nodes were decreased in 9 and 2 patients respectively.Conclusions 177Lu-PSMA-617 has a good therapeutic value for mCRPC.It is safe and has no obvious side effects.

Objective:To observe the curative effect of cervical chiropractic for cervical spondylosis of vertebral artery type (CSA) and to explore its possible mechanism.Methods:Sixty CSA patients were randomly divided into two groups.Thirty patients in the treatment group were treated with chiropractic manipulation for cervical vertebrae,once every other day,7 treatments in total.The other 30 patients in the control group received oral administration of flunarizine hydrochloride,10 mg per night,for 14 d.Cervical vertigo and functional assessment scale and transcranial cerebral Doppler (TCD) were measured before treatment and 7 days after treatment.Results:The total effective rate was 96.7％ in the treatment group and 83.3％ in the control group.The curative rate was 66.7％ in the treatment group and 20％ in the control group.The differences between the two groups in the total effective rate and the curative rate were statistically significant (both P＜0.05).The scores of cervical vertigo symptom and functional assessment after treatment in both groups were significantly higher than those before treatment (both P＜0.01);the difference between the two groups was statistically significant (P＜0.05).After treatment,the maximum systolic velocity (Vs),the maximum diastolic velocity (Vd),the mean velocity (Vm),the pulsatility index (PI) and the vascular resistance index (RI) in both groups were significantly improved compared with those before the treatment (all P＜0.01);there were significant differences between the two groups (all P＜0.05).Conclusion:Cervical chiropractic is an effective method for CSA,and its curative effect is better than that of flunarizine hydrochloride alone.Its mechanism may relate to correcting cervical instability.

Objective To establish a mouse model of immune treatment of asthma through subcutaneous injection with high dose of ovalbumin( OVA) in the abdomen and investigate the role of IL-23/Th17 axis response in its mechanism. Methods With a random number table method, 18 female BALB/c mice were divided into 3 groups( normal control group,asthma group and asthmatic immune tolerance model group) ,with 6 mice in each group. The mice in the asthmatic immune tolerance model group were sensitized with 10 μg OVA by intraperito-neal injection in the abdomen on day 0 and day 7. The mice in the model group induced immune tolerance with 1 mg OVA by subcutaneous injection in the abdomen every day for a week(day 21 to day 27). Both the model group and asthma control group were challenged with 1％OVA on day 35 to day 41. The mice in the normal control group were challenged with the equal amount of saline. On the 50th day,each group were sforzando challenged once with 10％ OVA. The airway reactivity was detected at 24 after the last challenge. The enhanced pause( Penh) was measured to evaluate the airway responsiveness with a lung functional instrument. Bronchoalveolar lavage fluid( BALF) was collected to count the total cells and eosinophils,and the cytological studies were conducted. The OVA-specific IgE in peripheral blood,and the IL-5,IFN-γIL-23,IL-10 in BALF were detected by enzyme-linked immunosorbent assay(ELISA). The lung tissue was obtained to perform histological analysis by HE staining. The percentagea of Treg and Th17 cells in spleen and lung tissue were calculated by the flow cytometry( FCM) . Then the expression of transcription factors was detected by q-PCR. Results For the asthmatic immune tolerance model group, the airway respon-siveness,the cell count of eosinophilic granulocytes in BALF,the levels of IL-23 and OVA-specific IgE in the serum were significantly lower than the asthma group and the difference is of statistical significance(P<0. 05),while the difference in the IFN-γlevel in BALF compared with the asthma group is of no statistical significance(P<0. 05). The transcription factor of lung tissue detected with q-PCR showed Foxp3 in the asthmatic immune tolerance model group was significantly higher than the asthma group,while RORγt was significantly lower than the asthma group(P>0. 05) and the differences were of statistical significance(P<0. 05). Conclusion Large dose of OVA specific immuno-therapy can alleviate the chronic inflammatory response of asthmatic mice, and the decrease of Th17 cells associated with the expression of IL-23 was decreased. The mechanism may be related to the correction of the lung Il-23 /Th17 axis.

At present,because market price survey and health insurance payment standard adjustment mechanism in china is incomplete,health insurance payment standard can not be completely equivalent to the actual market price of drugs. This paper analyzed and summarized the main factors affecting the balance and formation mechanisms under differ-ent medical insurance payment standard policies. It is found that the balance formation mechanism depends not only on the reimbursement ratio of drugs,but also on the development pattern of the payment standard and on the source of the refer-ence price system selected. On the issue of the ownership of the balance,from the specific practices of pilot cities such as Chongqing and Shaoxing,it can be seen that the merits and demerits still exist to the medical institutions for internal de-velopment models or re-allocated by the government agencies'performance-based. Compared with the simple balance reten-tion model,the redistribution model can enhance the service of medical institutions by regulating their behavior. However, medical institutions may provide false data to get more balance in the redistribution model,and game theory was used to reduce the policy risk of misreporting the private balance of data from medical institutions,and the analysis of strategic choices of medical institutions and supervisory departments Finally,"three-step"policy proposal was proposed on the issue of balance attribution. In the short term,the balance should be given to the medical institutions to increase their bargaining motivation. At the same time,the performance appraisal and supervision methods should be explored to enhance the feasi-bility of redistribution model. In the long run,the balance should be eliminated gradually through the improvement of mar-ket price survey and medical insurance payment standard adjustment mechanism.

Screening out the safety-related substances and establishing the corresponding standard has been a key research issue to improve the safety of traditional Chinese medicine injections(TCMIs). 5-HMF which widely exists in sugar-containing TCMIs has long been considered as an important safety-related substance. In this review, we summarizes the research progress on the toxicology of 5-HMF as well as the content and standards of 5-HMF in TCMIs.Therein, both literature summary and analysis results indicate that there are lack of toxicology researches of 5-HMF and its metabolites in TCMIs, although the potential toxicity of 5-HMF and its metabolites has been reported. Moreover, the content of 5-HMF largely varies from TCMIs to TCMIs, and even in the same TCMIs from different factories. To ensure the clinical efficacy of TCMIs, it urgent to carry out the study of the toxicology of 5-HMF in TCMIs comprehensively and systematically, so as to set up a relatively uniform standard as well as to develop process quality control method.

OBJECTIVETo investigate the influence of registration based on different reference markers on the displacement of the geometry consisted of all clips in the cavity for external-beam partial breast irradiation at moderate deep inspiration breath holding assisted by active breathing control device.

METHODSTwenty-seven early stage breast cancer patients feasible for external beam partial breast irradiation (EB-PBI) were selected. The patients undertaken three-dimensional computed tomography (3DCT) simulation scan at moderate deep inspiration breath holding (mDIBH) assisted by active breathing control device, and two sets of mDIBH CT images were got and transferred to the Pinnacle 3 planning system. All of the silver clips were delineated and a geometry consisted of all clips were generated. On the account of automatic registration of mDIBH CT images, manual registration was carried out based separately on the topside clip in the cavity, the labeled skin at anterior surface of the cavity at central level and the metal mark on the body surface near the cavity, then the displacements of center of the geometry in left-right (LR), anterior-posterior (AP) and superior-inferior (SI) directions based separately on the three registrations were measured.

RESULTSThe displacements of center of the geometry in LR, AP and SI directions based on registration of the clips, the labeled skin and the metal mark were (0.61 ± 0.62)mm vs. (1.11 ± 1.21)mm vs. (1.31 ± 1.55)mm, (0.63 ± 0.59)mm vs. (0.92 ± 0.93)mm vs. (1.19 ± 1.24)mm and (0.91 ± 0.96)mm vs. (2.13 ± 2.12)mm vs. (1.93 ± 1.55)mm, respectively. Compared the displacements of center of the geometry in the same direction between the three registrations, significant differences were found only in SI direction between clip registration and skin registration, clip registration and mark registration (t = 5.045, 7.210 and P = 0.025, 0.007) . Compared the displacements of center of the geometry between three dimensional directions for each reference registration, there was no significant difference (all P > 0.05).

CONCLUSIONSWhen EB-PBI is carried out in state of mDIBH, measurement of the intrafraction displacement based on registration of the clip in the cavity is a reasonable selection. Otherwise, excessive margin enlargement of PTV in SI direction will be generated if the regional skin or metal mark is selected as registration reference.

Breast Neoplasms ; diagnostic imaging ; radiotherapy ; Breath Holding ; Female ; Fiducial Markers ; Humans ; Imaging, Three-Dimensional ; Radiography ; Radiotherapy Planning, Computer-Assisted ; methods ; Surgical Instruments

OBJECTIVETo explore the dosimetric variance in forward intensity modulated radiotherapy (IMRT) based on 4D CT and 3D CT after breast conserving surgery.

METHODSSeventeen patients after breast conserving surgery underwent 3D CT simulation scans followed by respiration-synchronized 4D CT simulation scans at free breathing state. The treatment plan constructed using the end inspiration (EI) scan was then copied and applied to the end expiration (EE), and 3D scans and dose distribution were calculated separately. Dose-volume histograms (DVHs) parameters for the CTV, PTV, ipsilateral lung and heart were evaluated and compared.

RESULTSThe CTV volume difference was biggest between T0 and 3D CT, and the volume difference was 4.10 cm(3). Mean dose of PTV at EE was lower than that at EI (P = 0.019), but there were no statistically significant difference between 3D and EI, EE (all P > 0.05). The homogeneity index (HI) at EI, EE, 3D plans were 0.149, 0.159 and 0.164, respectively, and a significant difference was only between EI and EE (P = 0.039). The highest conformal index (CI) was at EI phase (P < 0.05), and there was no significant difference between EE and 3D (P = 0.758). The V(40) and V(50) of ipsilateral lung at EE phase were lower than that at EI (P < 0.05). There were no significant differences in all the indexes for heart (P > 0.05).

CONCLUSIONSThe breast deformation during respiration may be disregarded in whole breast IMRT. PTV dose distribution is significantly changed between EI and EE phases, and the differentiation of the lung high dose area between EI and EE phases may be induced by thorax expansion. 3D treatment planning is sufficient for whole breast forward IMRT, but 4D CT scans assisted by respiratory gating ensures more precise delivery of radiation dose.

Adenocarcinoma, Mucinous ; diagnostic imaging ; radiotherapy ; surgery ; Adult ; Breast Neoplasms ; diagnostic imaging ; radiotherapy ; surgery ; Carcinoma, Ductal, Breast ; diagnostic imaging ; radiotherapy ; surgery ; Dose Fractionation ; Female ; Four-Dimensional Computed Tomography ; methods ; Humans ; Imaging, Three-Dimensional ; methods ; Mastectomy, Segmental ; Middle Aged ; Organs at Risk ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated ; Respiration