Objective:To evaluate the safety and feasibility of applying injectable cross-linked sodium hyaluronate isolation gel in radical hypofractionated radiation therapy for prostate cancer.Methods:In this prospective study, patients at Beijing Hospital who were pathologically diagnosed with clinical stage T 1-2N 0M 0 prostatic acinar adenocarcinoma by puncture and underwent radical radiation therapy were included. All patients received ultrasound-guided cross-linked sodium hyaluronate isolation gel injection and image-guided intensity-modulated radiation therapy (IG-IMRT). The prescription dose was moderately hypofractionated, with a prescription dose of 60 Gy in 20 fractions for 5 times a week, once daily, which was delivered to 95% of the planning target volume (PTV) of prostate and seminal vesicle. Analyze the prostate rectal spacing (PRS) at the baseline, on the day of injection, during the radiotherapy, 1 month and 3 months after radiotherapy, changes in rectal volume before and after injection, and incidence of rectum-related side effects. The changes in all indexes before and after injection were analyzed by using t-test. Results:A total of 13 patients were enrolled from March 2022 to February 2023. The isolation gel maintained morphologic stability without significant spatial changes during radiotherapy, and the mid-prostate had the best effect, with PRS up to 1 cm. At 3 months after radiotherapy, the isolation gel was seen to decreased in volume with a certain absorptive capacity. The irradiated volume of rectum was decreased significantly in all patients after gel injection, and the mean volumes of rectal V 60 Gy , V 50 Gy , V 30 Gy , and V 20 Gy before and after injection were 1.923% vs. 0.280%, 10.255% vs. 3.172%, 29.602% vs. 18.800%, and 49.452% vs. 40.259% (all P<0.005). The average values (range) of rectal V 60 Gy , V 50 Gy , V 30 Gy , V 20 Gy decreases were 84.9%( 29% - 100%), 69.6%(27%-100%), 36.3%(0%-75%), and 17.8%(0%-50%), respectively. No grade 3-4 side effects occurred in all patients, and there were no common grade 1-2 rectal side effects such as diarrhea, rectal bleeding, proctitis and anal pain, etc. Only one patient developed grade 1 constipation during radiotherapy. Conclusion:Injection of Chinese made cross-linked sodium hyaluronate isolation gel can significantly reduce the irradiated volume of rectum and the incidence of rectal toxicities in prostate cancer patients undergoing radical radiotherapy.

Radiation therapy (RT) is a well-established and widely used treatment modality for prostate cancer. As prostate-rectum proximity contributes to rectal toxicity, there is growing interest in rectal protection. Technical advances have enabled the reduction of rectal injury. To improve the safety of prostate cancer radiotherapy and minimize the rectal toxicity of irradiation, the advances in rectal protection technique during prostate cancer radiotherapy, including technical advances of radiation therapy, image-guided radiotherapy, application of endorectal balloons, and use of rectum spacers, were reviewed, aiming to provide reference for improving the safety of prostate cancer radiotherapy and alleviating rectal radiation injury.

OBJECTVE To study the effects of Zhilong huoxue tongyu capsules on intracerebral hemorrhage ，long non-coding RNA（LncRNA）and its target genes in mice. METHODS Twenty-four male C 57BL/6 mice were randomly divided into sham operation group 1，model group 1 and Zhilong huoxue tongyu capsule low-dose and high-dose groups （0.35，1.40 g/kg）. Collagenase was injected into the caudate nucleus to construct the model of intracerebral hemorrhage. One hour after the operation ， the mice in each treatment group were given the corresponding medicinal solution ，and the mice in the sham operation group 1 and the model group 1 were given normal saline intragastrically ，once a day ，for 3 consecutive days. The morphological changes of the brain tissue of the mice in each group were observed by hematoxylin-eosin staining and Nissl staining. The protein and mRNA expression of interleukin- 1β（IL-1β）and tumor necrosis factor-α（TNF-α）in the brain tissue were detected by immunohistoche- mistry，Western blot and real-time quantitative polymerase chain reaction （PCR）. In addition ，9 of male C 57BL/6 mice were randomly divided into sham operation group 2，model group 2 and intervention group （Zhilong huoxue tongyu capsule 1.40 g/kg）. The mice were modeled and administered according to the above method ，and then the whole brain tissue of mice in E-mail：tanruizhi627@swmu.edu.cn each group was isolated ， total RNA was extracted and sequenced，followed by analyzing the different LncRNA. Gene ontology（GO）enrichment was performed to predict effective LncRNA and target genes ，and verified by real-time quantitative PCR. RESULTS Compared with model group 1，the brain tissue pathological damages were significantly improved in Zhilong huoxue tongyu capsule low-dose a nd high-dose groups ，and the IL -1β， TNF-α protein and mRNA expression in brain tissue were significantly decreased （P＜0.05）. Two effective LncRNAs were screened out. The results of in vivo verification test （LncRNA-Dlst-211 was highly expressed in model group 2，and significantly down-regulated after the intervention of Zhilong huoxue tongyu capsules ； LncRNA-Dlst-211 target genes Rps 6kl1 and LncRNA-MSTRG.8169.4 were expressed weakly in model group 2，and strongly up-regulated after intervention ）were consistent with the sequencing results. CONCLUSIONS Zhilong huoxue tongyu capsules can improve the brain injury and inflammatory response in intracerebral hemorrhage model mice ，and its mechanism may be related to down-regulating the expression of LncRNA-Dlst-211 and up-regulating the expression of LncRNA-MSTRG. 8169.4 and Rps 6kl1.