Objective To observe the physique and anatomy changes in patients with nasopharyngeal carcinoma (NPC) during intensity-modulated radiotherapy (IMRT), using repeated CT images and deformable registration technique, and analyze their impact on delivery dose distribution.Methods Ten NPC patients were randomly selected from those who had received IMRT treatment.Gross tumor volume of nasopharyn (GTVnx), GTV of metastastatic lymph node (GTVnd), clinical target volume (CTV) and normal tissue or organ (OAR) were re-contoured on the in-course repeated CT images using a kind of deformable registration and auto-segmentation software according to the original planning contouring.Changes in volume of treatment targets and organs at risk were evaluated and the trends were then analyzed.Dose distributions were recalculated with repeated CT images and compared to the original plans.Results The volume of GTVnx were decreased by 6.44%,10.23% and9.72%(F=1.34,P=0.278) in the 2-,4-and 6-week after IM RT comparing with before IM RT, with 6.59%, 30.98 % and 35.13 % (F = 9.22, P =0.000) in GTVnd, 0.73%, 1.86% and 1.41% (F=0.33,P=0.722) in CTV1, -1.78%, -6.47%and -9.34% (F =16.89 ,P =0.000) in CTV2, 13.96%, 32.97% and 37.77%(F=17.17,P=0.000)in the left parotid , and 3.56% , 29.57% and 35.63% (F = 13.49 , P = 0.000) in the right parotid.The mean dose change rate of GTVnx were -0.39%, 0.08% and 0.32% (F =0.15 ,P =0.860) in the 2-,4- and 6-week after IMRT comparing with planning faction dose, with 0.53%, 1.19% and 0.69% (F=0.81,P=0.455) in GTVnd, 1.95%, 2.70% and 3.78% (F=0.61,P=0.552) in the spinal cord,0.32%, 0.81% and 0.62% (F=0.03,P=0.975) in the brain stem, 4.50%, 4.66% and 7.20% (F=0.33,P=0.725) in the left parotid, 2.20%, 7.17% and 7.12% (F= 1.24,P=0.306) in the right parotid.Conclusions The GTVnd, CTV2 and parotids shrinks obviously along with the treatment times for NPC patients during IMRT.Although changes in fraction dose of GTV, CTV, spinal cord, stem and parotids are not significant, further study with larger samples is needed.

Objective To study the clinical value of orbital magnetic resonance imaging(MRI) in diagnosis and making a judgment about the curative effect of glucocorticoid in patients with Graves' ophthalmopathy (GO).Methods A total of 106 patients with GO were divided into active GO group or inactive GO group according to whether clinical activity score(CAS) ≥3 or not,respectively.T2 relaxation times(T2RTs) (ms) and areas(mm2) of four extra-ocular muscles (EOMs) (superior,inferior,medial,and lateral rectus) were directly measured by MRI T2-Mapping.Correlation analysis of T2 RTs and areas with eyeball motility,diplopia,exophthalmus,visual acuity and intraocular pressure (IOP) were also performed.The T2RTs and areas of EOMs before and after intravenous methylprednisolone(iv MP) pulse therapy were recorded,respectively.Results The mean T2RTs (88.9 ± 13.8)and mean areas(58.1 ± 23.8) of EOMs in active GO were significantly greater than those in inactive GO (80.6 ± 10.0and 46.2 ± 18.6,respectively),bing both significantly greater than those in volunteers with normal eyes(76.2 ±4.7and 30.3 ± 6.1,respectively) (P＜0.01).Maximal T2RTs and maximal areas of EOMs showed significant positive correlation(P＜0.01),and both were positively correlated weakly with CAS,reduced movement of eyeball,diplopia,exophthalmus and loss of visual acuity (P＜0.01).On the contrary,maximal T2RTs and maximal areas of EOMs showed negative correlation or no correlation with spontaneous retrobulbar pain,painful eye movement,redness of eyelids and abnormal IOP.Even if 1 ≤ CAS＜3,ophthalmic symptoms and signs also showed a positive responses to iv MP in patients with moderate to severe GO as long as prolonged T2RTs occurred at least in one of EOMs.The maximal T2RTs,maximal areas,mean T2RTs and mean areas of EOMs were significantly decreased at the end of iv MP treatment,meanwhile ophthalmic symptoms and signs were obviously improved.Conclusions Prolonged T2RTs,especially accompanied by enlarged area on the identical EOMs is an remarkable symbols of acute inflamed muscles.The findings suggested that the use of prolonged T2RTs can improve diagnostic sensitivity and predict the curative effect of iv MP in patients with moderate to severe GO and CAS ≥ 1.

To introduce the diagnosis and treatment of one male case with accessory breast. The patient was a 27-year-old male. An additional nipple on the left posterior axillary line was found on birth, which enlarged and became darken since adolescence. The clinical diagnosis was accessory breast, and a complete surgical excision was performed. Pathological examination proved the diagnosis of accessory breast.

Objective To study the application value of modified urine nucleoside's detection in prognosis of patients with bladder cancer. Methods We enrolled 85 patients with bladder transitional cell carcinoma confirmed by pathological examination.The 85 patients fulfilled one-year follow-up visit after TUR-BT and were reviewed every three months.The 85 patients did not relapse in the first third month after operation.At the sixth month after operation,20 cases relapsed.18 cases and 19 cases relapsed at the ninth month and the twelfth month after operation.Patients with recurrence added up to 57 cases as the recurrent group.The remaining 28 cases did not relapse at one year after operation as the no recurrent group.Of the 85 cases,55 cases were in T(is) - T1,while 30 cases were in T2 - T4.Of the 85 cases,27 cases were with G1,40 cases were with G2 and 18 cases were with G3.In T(is) -T1,there were 35 cases in recurrent group,while there were 20 cases in the no recurrent group.In T2 -T4,there were 22 cases in recurrent group,while there were 8 cases in the no recurrent group.There were 50 normal people in the control group.Highperformance liquid chromatography/electrospray ionization-quadrupole-time-of-flight mass spectromerry was used to measure the levels of change of two urine modified nucleosides (M1A,1-MeI) which the patients with bladder cancer had different pathology grades,clinical stages,before or after operation and recurrence or no recurrence. Results The levels at third month after operation in no recurrent group ( M1A:3.24 ± 0.40,1 -MeI:5.73 ± 0.67 ) were significantly lower than that before operation ( M 1A:4.34 ± 0.98,1-MeI:14.22 ± 4.05,P ＜ 0.005 ),and remained in low status at another time points after operation.The levels at the third month after operation in recurrent group (M1A:3.31 ±0.33,1-MeI:5.67 ±0.55) were significantly lower than that before operation ( M1A:4.32 ± 1.19,1-MeI:14.31 ± 4.12,P ＜ 0.005 ),which was on the rise and indicating a high level approaching the condition before operation.According to the time point before the operation,recurrent group and no recurrent group were higher than control group (M1A:2.91 ±0.84,1-MeI:5.56 ± 1.25,P ＜ 0.01 ).The levels at the sixth month,ninth month and twelfth month after operation in recurrent group ( M 1A referring to 4.04 ± 0.48,4.11 ± 0.47,4.09 ± 0.53 ;1-MeI referring to1 1.46 ± 1.34,12.14 ± 1.22,12.33 ± 1.27) were the highest (P ＜ 0.01 ).The levels of change of two urine modified nucleosides between pathology grade and clinical stage had no statistical difference ( P ＞ 0.01 ).The levels in recurrence group in T(is) - T1 ( M1 A:5.92 ± 1.28,1-MeI:20.01 ± 8.53 )were higher than the levels in no recurrent group ( M1A:4.02 ±1.22,1 -MeI:11.21 ± 6.45,P ＜ 0.05 ),which was the same in T2 - T4. Conclusion Urine modified nucleosides detection offer a certain clinical value the prognostic of operated bladder cancer patients.

Objective:To explore the correlation between early pupillary light reflex reduction and delirium in mechanically ventilated patients receiving sedation in the Intensive Care Unit (ICU) .Methods:From December 2020 to March 2021, convenience sampling was used to select 97 ICU patients with mechanical ventilation who received sedation in the China-Japan Union Hospital of Jilin University as the research subject. On the second to fourth days of the patient's stay in the ICU, the quantitative pupillary light reflex (q-PLR) and pupillary contraction velocity (CV) of the patients after photostimulation were measured by an automatic infrared pupillometer with a frequency of two times a day. Patients were assessed using the Richmond Agitation-Sedation Scale (RASS) . When the RASS score was≥-2, the patient was screened for delirium using the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) with a frequency of two times a day. According to the screening results, patients were divided into delirium group and non-delirium group.Results:The incidence of delirium in 97 ICU mechanically ventilated patients who received sedation was 58.76% (57/97) . Binomial Logistic regression showed that q-PLR on the second day was an influencing factor for delirium in mechanically ventilated ICU patients receiving sedation ( P<0.05) . Conclusions:Early pupillary light reflex reduction is associated with delirium in mechanically ventilated ICU patients receiving sedation.

Objective:To analyze the clinical manifestations,imaging characteristics,treatment measures,and efficacy of mitral valve aneurysm(MVA),and to enhance the clinicians'understandings of MVA.Methods:The clinical data of one patient with aortic valve bicuspid malformation leading to mitral valve anterior leaflet aneurysm were collected.The clinical diagnosis was confirmed based on the clinical characteristics and imaging features,the treatment methods were selected,and the efficacy was analyzed.The relevant literatures were reviewed.Results:The patient,a 68-year-old female,was admitted due to palpitations and shortness of breath for 13 years,and the symptoms worsened one month ago.Thirteen years ago,the patient experienced palpitations and shortness of breath without any inducement and was diagnosed with"heart valve disease"in the local hospital.The symptoms worsened one month ago,leading to hospitalization.The transthoracic two-dimensional echocardiography(TTE)results showed the left ventricular hypertrophy,bicuspid aortic valve with thickened and echogenic leaflets,the forward flow velocity was increased,and the aortic valve orifice area was 2.0 cm2;the mitral valve anterior leaflet margin was slightly thickened and echogenic,presenting a cystic"honeycomb-like"structure closely related to the aortic valve regurgitation jet,which appeared to enter the"sac".The preoperative transesophageal echocardiography(TEE)results showed the bicuspid aortic valve malformation with the anterior leaflet prolapsing into the left ventricular outflow tract during diastole;a"sac-like"structure was detected on the atrial surface of the mitral valve anterior leaflet,changing shape with the cardiac cycle and communicating with left ventricular blood flow.The ultrasound diagnosis was bicuspid aortic valve malformation with transverse fissure,severe regurgitation with mild stenosis,and mitral valve anterior leaflet aneurysm.Intraoperatively,the aortic valve annulus was enlarged with the significant leaflet regurgitation.The leaflets were excised,and a 23 mm bioprosthetic valve was implanted in the aortic position.Upon exploration through the aortic valve orifice,a"sac-like"structure was found on the mitral valve anterior leaflet,which was not specially treated.The postoperative TEE results showed good echo and activity of the aortic bioprosthetic valve,and the"sac-like"structure on the mitral valve remained unchanged.The follow-up results at 10 d and 4 months after operation showed good echo and activity of the aortic bioprosthetic valve,and compared with before operation,there was no significant change in the nature and size of the mitral valve cystic lesion.Conclusion:MVA is clinically rare.TTE is currently the most valuable imaging diagnostic method for MVA,especially when combined with TEE,which is the best diagnostic method and can assist in the treatment and efficacy evaluation.

Objective:To explore the application effect of health management in extended nursing for patients with hemorrhagic stroke.Methods:Using the convenient sampling method, a total of 120 patients with hemorrhagic stroke who were admitted to the First People's Hospital of Lianyungang in Jiangsu Province from August 2018 to August 2019 were selected as the research objects. According to the random number table method, they were divided into the control groups and the observation group, with 60 cases in each group. The control group and the observation group were respectively given traditional family follow-up nursing and extended nursing based on health management. The mastery degree of knowledge about hemorrhagic stroke disease, self-health management ability, medication compliance and psychological status of patients with hemorrhagic stroke were observed in the two groups.Results:After the implementation of extended nursing based on health management, the total scores of mastery degree of knowledge about nursing for hemorrhagic stroke and self-health management ability in the observation group were respectively (90.38±2.13) and (149.65±4.65) , which were higher than (59.07±2.45) and (115.79±5.34) of the control group, and the differences were statistically significant ( P<0.01) . The total compliance rate of patients in the observation group was 86.67% (52/60) , which was higher than 43.33% (26/60) in the control group, and the difference was statistically significant ( P<0.01) . After the intervention, scores of SDS and SAS of the observation group were (41.87±8.23) and (40.68±7.34) , which were lower than (54.23±7.45) and (52.02±9.86) of the control group, and the differences were statistically significant ( P<0.01) . Conclusions:The extended nursing based on health management is well applied in the family follow-up work of patients with hemorrhagic stroke. Mastery degree of knowledge of patients, self-health management ability, and treatment compliance are improved and levels of depression and anxiety are reduced.

Objective:To explore the effect of manual prompts in the first detection of lung function and fractional exhaled nitric oxide (FeNO) in patients with airway inflammation of unknown origin.Methods:From May 2018 to December 2020, convenience sampling was used to select 810 patients with airway inflammation of unknown origin in the Department of Respiratory of the China-Japan Union Hospital of Jilin University as the subject. Subjects were divided into a observation group ( n=406) and a control group ( n=404) . This study compared the quality control parameters of lung function detection [forced expiratory time (PET) , backward extrapolated volume (VBE) , time from forced expiratory to peak flow rate (FET-PET) , percentage of backward extrapolated volume to forced vital capacity (VBE/FVC%) ] , reproducibility parameters [variation between optimal and suboptimal forced vital capacity (ΔFVC) , variation between optimal and suboptimal first second forced expiratory volume (ΔFEV 1) ] , and detection efficiency indicators (detection time for lung function and FeNO, one-time success rate of FeNO detection) between two groups. Results:The VBE/FVC%, ΔFVC, and ΔFEV 1 in the observation group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . The lung function and FeNO detection time of the observation group were shorter than those of the control group, and the one-time success rate of FeNO detection was higher than that of the control group, with statistical differences ( P<0.05) . Conclusions:In lung function and FeNO detection for the first time among patients with airway inflammation of unknown origin, manual prompts can improve the quality control and reproducibility of the detection, shorten the detection time, and increase the one-time success rate of FeNO detection.

Objective:To investigate changes in the expression of Cosmc and T-synthase in peripheral B lymphocytes and in serum levels of galactose-deficient IgA1 (Gd-IgA1) in patients with Henoch-Sch?nlein purpura (HSP) .Methods:From January to August 2014, 56 patients with HSP were collected from outpatient or inpatient department of dermatology and venereology in the Second Hospital of Hebei Medical University, and were divided into 4 groups, including skin type group (22 cases) , joint type group (9 cases) , abdominal type group (12 cases) and renal type group (13 cases) . Twenty healthy volunteers served as healthy controls. Real-time fluorescence-based quantitative PCR was performed to determine the mRNA expression of Cosmc and T-synthase in peripheral B lymphocytes, and a lectin-based enzyme-linked immunosorbent assay (ELISA) to detect the serum level of Gd-IgA1. Comparisons among multiple groups were performed using one-way analysis of variance or Kruskal-Wallis H test, multiple comparisons were performed using least significant difference (LSD) - t test or Nemenyi test, and correlation analysis was performed using Spearman rank correlation analysis. Results:There was a significant difference in the duration from disease onset to the clinic visit ( χ2= 26.19, P < 0.05) among the skin type group (6.27 ± 3.09 d) , joint type group (5.56 ± 3.05 d) , abdominal type group (6.75 ± 3.75 d) , and renal type group (26.23 ± 14.12 d) , and the duration from disease onset to the clinic visit was significantly longer in the renal type group than in the other 3 groups (all P < 0.05) . The Cosmc mRNA expression significantly differed among the skin type group, joint type group, abdominal type group, renal type group and healthy control group (0.849 ± 0.239, 0.767 ± 0.181, 0.719 ± 0.183, 0.459 ± 0.121, 1.146 ± 0.232, F= 23.37, P < 0.05) , was significantly lower in the 4 patient groups than in the healthy control group ( P < 0.01) , and lower in the renal type group than in the other 3 patient groups (all P < 0.01) . There was no significant difference in the T-synthase mRNA expression in peripheral B lymphocytes among the patient groups and healthy control group ( F= 1.05, P > 0.05) . The serum level of Gd-IgA1 significantly differed among the skin type group, joint type group, abdominal type group, renal type group and healthy control group ( F= 7.06, P < 0.05) . Moreover, the Gd-IgA1 level was significantly higher in the patient groups than in the healthy control group (all P < 0.05) , and higher in the renal type group than in the other 3 patient groups (all P < 0.05) . The serum level of Gd-IgA1 in the HSP patients was significantly and negatively correlated with the mRNA expression of Cosmc ( rs=-0.50, P < 0.01) . Conclusion:Decreased mRNA expression of Cosmc and increased serum levels of Gd-IgA1 were observed in patients with HSP, and there was a negative correlation between the two indices.

Hexokinase(HK),as the first rate-limiting enzyme for glycolysis,promotes tumor progression by improving levels of aerobic glycolysis in tumor cells.By binding to the voltage-dependent anion channel(VDAC)on the outer mitochondrial membrane,HK2 is involved in increasing the stability of mitochondrial membranes,thereby inhibiting apoptosis of tumor cells and promoting tumor survival,which is why HK2 may be one of the factors that promote tumor resistance to chemotherapy drugs.This article reviews the research progress in the role of HK2 in tumor glucose metabolism,mitochondrial apoptosis and drug resistance.