Aim To investigate the roles of FFJ-5 in human breast cancer MCF7 cells and drug-resistant MCF7/DOX cells and to explore its mechanisms. Methods MTT assay was used to detect the effect of FFJ-5 on MCF7 and MCF7/DOX cell proliferation and sensitivity of doxorubicin in MCF7/DOX cells.West-ern blot was used to investigate the effect of FFJ-5 on expression of EGFR,p-EGFR,Akt,p-Akt,PKM2, cleaved caspase-3,cleaved PARP and P-gp.DNA lad-der analysis was performed to determine the effect of FFJ-5 on genomic DNA.RT-PCR was performed to de-tect the influence of FFJ-5 on multidrug resistance gene MDR1 mRNA levels.Results The results showed that FFJ-5 inhibited the growth of MCF7 ,inhibited the expression and activity of EGFR and Akt,and conse-quently reduced the expression of PKM2 in MCF7 cells;FFJ-5 activated caspase-3 and induced genomic DNA fragmentation;FFJ-5 also inhibited the growth of MCF7/DOX cells and enhanced the anti-tumor activity of doxorubicin in MCF7/DOX cells.Conclusion The results suggest that FFJ-5 could inhibit MCF7 cell growth and induce MCF7 cell apoptosis through inhibi-tion of EGFR-Akt-PKM2 pathway and activation of ap-optosis-related factors caspase-3 , meanwhile FFJ-5 could also reverse the resistance of MCF7/DOX.

Objective To prepare a new thrombus model by fluid model method , which is suitable for evaluation of mechanical thrombectomy devices for acute stroke.Methods The fluid model adopted the Chandler loop theory , while the static model adopted conventional method.Mechanical properties of thrombi prepared by fluid model and static model were measured by manual elongation test ( 15 samples in each group) and catheter injection test (15 samples in each group ).Histological structure was compared among the above thrombus models ( 5 samples in each group ) and specimens of five patients with stroke by hematoxylin-eosin staining method.Then, thrombi in fluid model were utilized to establish embolization of vessels in swine model ( two pigs ) for evaluation of radiopacity.Independent-Sample test was performed to compare the maximum tensile length of two methods , and Fisher′s exact test was used to compare the rate of thrombus fragmentation after catheter injection test.Results The maximum tensile length of two models were (4.28 ±0.23) and (3.16 ±0.13) cm, respectively, and the difference was statistically significant (t=16.38, P<0.01);After catheter injection, the fracture rates of thrombus were 13% (2/15) and 60%(9/15), which were also statistically significant (P<0.05).As to histological structure, thrombi prepared by fluid model showed mixed thrombus structure , which similar to thrombi of stroke patients , But thrombi prepared by static model were replete with erythrocytes under the microscope .A total of eight vessels ( lingual arteries and superficial cervical arteries ) in two swines were successfully occlusive ( TIMI 0 or 1 ) , and sufficient radiopacity of each injected thrombus was observed.Conclusions The thrombi prepared by fluid model not only have good mechanical stability and sufficient radiopacity , but their histological structure is similar to thromboemboli retrieved from cerebral arteries of patients with acute stroke.

Objective:To investigate the variations and related influencing factors of the volumes, positions, and morphologies of geometries formed by surgical clips in intensity-modulated radiation therapy (IMRT) for whole breasts after breast-conserving surgery.Methods:A retrospective analysis was conducted on 18 patients treated with IMRT from October 2021 to September 2022 after breast-conserving surgery. Set-up errors were obtained by reading the coordinate information of tumor bed surgical clips according to the cone beam CT (CBCT) images at 0, 10, 20, 30, 40, and 50 Gy sequentially. Geometries were constructed using the convex hull program, and the volumes ( Vct and V0-5) of geometries were then calculated based on the localization CT images and the six CBCT images, respectively. The centroid displacements ( D0-5) and degrees of inclusion ( DI0-5) of these geometries were compared. The t-test or rank-sum test was used to analyze the effects of radiation doses on V0-5, D0-5, and DI0-5. The Pearson correlation analysis was conducted to analyze the correlations between D0-5 and corresponding set-up errors in three-dimensional directions, and the correlations of average V0-5 variation ( AV), average D0-5 ( AD), and average DI0-5 ( ADI) with the body mass index (BMI), the volume of a breast ( VB), the breast axial height ( H), and the time interval from surgery to radiotherapy ( T) each. The influences of quadrants ( Q) where geometries are located and states ( S) of geometries adhering to or away from the chest walls on AV, AD, and ADI were analyzed through one-way ANOVA. Results:The differences between D5 and D0, between D5 and D1, and between D5 and D2 were statistically significant ( t = -3.27, -4.52, -3.38, P < 0.05), respectively. The differences between DI5 and DI0, between DI5 and DI1, between DI5 and DI2 were statistically significant ( t = 2.53, 2.70, 2.64, P < 0.05), respectively. D1 and D4 correlated with the set-up errors in the superior-inferior dimension, and D3 correlated with the set-up errors in the left-right dimension ( r = 0.50, 0.56, 0.53, P < 0.05). The AD was related to BMI, VB, and H ( r = 0.54, 0.48, 0.50, P < 0.05). There were statistically significant differences in AV and ADI of geometries away from ( S3) and near ( S2) chest walls ( F = 2.66, 3.83, P < 0.05). The AD differences of geometries between S3 and the state adhering to chest walls ( S1) and between S3 and S2 were statistically significant ( F = 7.46, P < 0.05), respectively. Conclusions:The geometries are relatively constant volumes during whole-breast radiotherapy. However, their positions and morphologies vary greatly in the late course. The volume variation ratios, centroid displacements, and degrees of inclusion of geometries are all affected by the states of their attachments to the chest walls. The centroid displacements correlate with breast morphologies and BMI. The radiotherapy plan modification can be individualized.

Objective:To explore the affects of the filling degree of the abdominal and pelvic cavity to the position of the diaphragm.Methods:The computed tomography (CT) images of 25 patients from 137 CT scans stored in the Picture Archiving and Communication System of the First Affiliated Hospital of Soochow University from March 2018 to September 2020 were reviewed and analyzed retrospectively. Every patient was scanned 4-7 times. The outline of the abdominal and pelvic cavity from the diaphragmatic dome to the superior margin of pubic symphysis was drawn at every cross section, and then the filling volumes of the abdominal and pelvic cavities and the overall filling volume were calculated. For the same patient within 4-7 CT scans, per pair of different images was compared randomly and 379 comparison pairs were obtained. The volume change rate (△ VR) of the abdominal and pelvic cavity and the height difference (△ H) of the diaphragmatic dome were calculated. The images with "larger overall filling volume of the abdominal and pelvic cavity and higher diaphragmatic dome" were defined as consistent group, and those with "larger overall filling volume and lower diaphragmatic dome" were defined as inconsistent group. The percentage of images in the consistent group in all samples and the percentage of images showing deep inspiration in the inconsistent group in all samples were calculated. △ VR and △ H were compared between the consistent and inconsistent groups. △ VR of the abdomen and pelvic cavities in the consistent group was compared using the Mann-Whitney test. The correlations between △ VR of the abdomen and pelvic cavities and the elevation of the diaphragmatic dome in the consistent group were analyzed using Spearman correlation analysis. The average elevation of the diaphragmatic dome in all samples and the consistent group was simulated if the filling volume of the abdomen and pelvic cavity was increased by 500 ml. Results:The percentage of images in the consistent group in all samples was 67.28%. The percentage of images showing deep inspiration in the inconsistent group in all samples was 26.39%. There were significant differences in △ VR and △ H of the abdomen and pelvic cavity between the consistent and inconsistent groups ( Z=-4.95, -5.49, P<0.05). In the consistent group, there were significant differences in △ VR between the abdominal cavity and pelvic cavity ( Z=-7.53, P<0.05), and the elevation of the diaphragmatic dome was correlated with the △ VR of the abdominal cavity ( rs=0.43, P<0.05). The simulated calculation showed that an average increase of 500 ml in the filling volume of the abdominal and pelvic cavity result ed in an average elevation of 4.54 and 8.43 mm in the diaphragmatic dome in all samples and the consistent group, respectively. Conclusions:The filling degree of the abdominal and pelvic cavity may be one of the main factors affecting the position of the diaphragm and the precision of radiotherapy for relevant organs near the diaphragm, especially the filling degree of the abdominal cavity. It is recommended to repeat the filling degree of the abdominal and pelvic cavity by CT localization scanning as much as possible during radiotherapy.

Objective:To analyze the activity of skin markers at different parts of the body surface and the correlations between their displacement deviations and pelvic filling volumes during conventional abdominal and pelvic radiotherapy.Methods:A retrospective analysis was conducted on 15 patients receiving abdominal and pelvic radiotherapy with four times of computed tomography (CT) in the First Affiliated Hospital of Soochow University from January 2020 to January 2022. All CT images were divided into nine parts from the upper edge of L3 to the upper edge of the pubic symphysis: upper, middle, and lower parts in the right portion; upper, middle, and lower parts in the central portion; and upper, middle, and lower parts in the left part portions, No. 1-9 in sequence. The same blood-vessel or fascia intersection points near the same skin parts receiving the same dose fraction were used as the markers for skin positioning during simulated radiotherapy. The relative coordinates of the markers were measured, with the same point at the lower edge behind the L5 vertebral body set as the coordinate origin. Through pairwise comparison of each patient′s four CT images, the three-dimensional displacement deviations and activity were calculated for all markers. In the left-right (L-R), superior-inferior (S-I), and anterior-posterior (A-P) directions, the differences in the displacement activity of the markers in the nine parts were compared using both the non-parametric Kruskal-Wallis test and the Descriptives. The correlations between the three-dimensional displacement deviations of all markers and the A-P displacement deviations of the No. 5 marker were analyzed using the Pearson correlation analysis.Results:Differences existed in the displacement activity of the nine-part markers in the L-R, S-I, and A-P directions ( H=36.66, 66.20, 92.15, P<0.05). No. 3 and 9 markers exhibited lower overall three-dimensional displacement activity (median: 2.40-3.75 mm) than other markers. The No. 5 marker manifested the highest A-P displacement activity, with a median of 9.20 mm. The A-P displacement deviation of No. 5 marker was correlated using the L-R displacement deviations of the No. 1, 2, 3, 7, 8 and 9 markers ( r=-0.36 to 0.49, P<0.05), the S-I displacement deviations of the No. 4, 5, 6, and 9 markers ( r=-0.34 to -0.24, P<0.05), and the A-P displacement deviations of the No. 1, 2, 3, 4, 6, 7, 8 and 9 markers ( r=0.33-0.91, P<0.05). Conclusions:Skin markers drawn in bilateral acetabular regions serve as the best choices for reposition in pelvic radiotherapy. Conventional skin markers made at the central parts are prone to suffer deviations in the S-I direction due to the influence of the abdominal and pelvic filling volumes.

BACKGROUND:The evaluation and management of cervical vascular pathologies before orthopedic manual therapy have great significance for reducing risks,ensuring patients'interests and promoting optimal clinical decision-making.However,the research and exploration of this field in China are still in its infancy.In 2020,the International Federation of Orthopaedic Manipulative Physical Therapists(IFOMPT)released the International Framework for Examination of the Cervical Region for potential of vascular pathologies of the neck prior to Orthopaedic Manual Therapy(OMT)Intervention:International IFOMPT Cervical Framework(2020).This framework has important references and guiding values for the clinical practice of cervical manipulation in China. OBJECTIVE:To integrate and interpret the core content of the framework,to provide a reference for the clinical practice of cervical manual therapy in China. METHODS:On the basis of a full study of the framework,the authors interpret the core content of the framework from eight aspects including clinical reasoning,patient history,planning the physical examination,physical examination,risk and benefit.Meanwhile,seven databases including PubMed,EMbase,Cochrane Library,CNKI,WanFang,VIP and China Biomedical Literature Service System databases were searched by computer to screen clinical practice guidelines and expert consensus on neck pain.Through longitudinal comparison of multiple high-quality guidelines and consensus,the authors combine with the clinical practice in China to carry out discussion and analysis. RESULTS AND CONCLUSION:This framework expounds the management strategy and implementation path of cervical vascular disease evaluation before cervical manipulation from multiple dimensions,suggesting that we should improve clinicians'attention to cervical vascular disease evaluation before manipulation,and construct evaluation criteria and implementation path with Chinese clinical characteristics.Meanwhile,we should further carry out basic scientific research with multidisciplinary techniques and promote shared decision-making and teaching model innovation to achieve the best clinical decision.

Objective:To study the risk factors of postoperative permanent hypoparathyroidism after total thyroidectomy.Methods:In this retrospective study ,the receiver operating characteristic (ROC) curve of postoperative 24 h parathyroid hormone(PTH) values was used to predict the risk of permanent hypoparathyroidism.The clinical and pathological features that related to postoperative permanent hypoparathyroidism were studied by χ2 test and multivariate Logistic regression analysis. Results:Eight hundred and eighty-nine patients were enrolled, the incidence of postoperative transient and permanent hypoparathyroidism was 33.3% and 4.0%, respectively. When 24 h PTH levels less than or equal to 5.84 pg/ml were used as cut off value, the sensitivity of the prediction of permanent hypoparathyroidism was 100%, the specificity was 72%, and the positive predictive value was 22.5%. The presence of parathyroid gland in the pathologic specimen, parathyroid autotransplantation and PTH≤5.84 pg/ml at 24 h after operation were statistically significant risk factor for permanent hypoparathyroidism in multivariate analysis( χ2=10.900, P=0.001; χ2=4.415, P=0.044; χ2=13.576, P=0.000). Group analysis found that the lower 24 h PTH the higher incidence of permanent hypoparathyroidism. Conclusions:For patients undergoing total thyroidectomy, when parathyroid gland is involved and/or the PTH value is low at 24 h after surgery, the occurrence of permanent hypoparathyroidism is high.

Postoperative complications of colorectal surgery are one of the most important reasons affecting patients' postoperative health and also an important factor increasing the burden of medical care. It can give policymakers a basis to the optimization of medical resources by clarifying the health economic burden of different postoperative complications through health economic evalua-tion. Through a detailed search of domestic and foreign literatures, the authors summarize and analyze the increased medical costs and prolonged hospital stays associated with postoperative anastomotic leak, surgical site infection, and postoperative ileus. Furthermore, the authors identify shortcomings in existing clinical studies of different mediacal centers for colorectal postoperative complications, in order to better guide future clinical researches related to colorectal postoperative complications.

Objective: To investigate the diagnostic performance of fine-needle aspiration (FNA) cytology for the detection of lateral lymph node metastases in patients with papillary thyroid carcinoma (PTC). Methods: A total of 109 lateral lymph nodes with suspicious metastases from 85 patients were retrospectively subjected to FNAC, fine-needle aspiration thyroglobulin measurement (FNATg), and FNATg/SerumTg measurement. Lymph node pathological results after surgery were taken as the gold standard. Using Mann-Whitney U test, Pearson linear model and ROC curve were used for data analysis. Results: The sensitivity, specificity and accuracy of FNATg for the diagnosis of lateral neck lymph node metastasis were respectively 93.7%, 90.0% and 93.3% and those of FNATg/SerumTg were respectively 89.9%, 90.0% and 93.2% respectively, the threshold values for FNATg and FNATg/SerumTg were 0.925 ng/ml and 1.007, respectively. The sensitivity, specificity and accuracy of FNATg combined with FNAC were respectively 91.0%,93.5% and 94.4%. The existence of thyroid tissue and the expression of serum Tg did not affect the expression of lymph node FNATg. The FNATg cutoff value of 0.925 ng/ml showed the best diagnostic performance in patients with a thyroid gland, while the FNATg/SerumTg cutoff ratio of 14.95 showed the best diagnostic performance in patients without a thyroid gland. The serum TgAb significantly interfered with the expression of FNATg in the lateral neck metastatic lymph nodes (P=0.049). Conclusions FNATg alone or the combination of FNATg with FNAC are highly reliable in the diagnosis of lateral neck lymph node metastases in patients with PTC. The expression of TgAb may interfere with the accuracy of the diagnostic performance of FNATg.

Objective: To study the diagnostic value of a multi-gene molecular testing in cytologically indeterminate thyroid nodules. Methods: From February 2018 to September 2018, patients with thyroid nodules who underwent fine needle aspiration(FNA) at Peking University Cancer Hospital were enrolled. Three hundred and sixty patients were included, consisting of 86 men and 274 women, with a mean age of 45.8 years (between 13 and 89 years old). Among 391 nodules, 141 were cytologically inderminate and 75 were resected. FNA samples underwent prospective testing using a next-generation sequencing (NGS) assay, which included 16 genes for point mutations and 26 types of gene fusions. The testing results of indeterminate nodules were compared with surgical outcomes, to determine the diagnostic performance. The results were compared with the BRAF V600E single gene mutation analysis by χ² test. Results: The multi-gene testing showed a sensitivity of 73.2%, specificity of 96.8%, positive predictive value of 96.8%, and negative predictive value of 73.2%. The diagnostic accuracy of multi-gene testing was significantly higher than the BRAF V600E mutation test (83.3% vs 73.6%, χ²=31.588, P<0.01). Conclusion Multi-gene testing in FNA samples is an effective method to diagnose cytologically indeterminate thyroid nodules, which has a higher accuracy than BRAF V600E mutation detection.