Objective To discuss the early diagnosis of severe perioperative biliary infection complicated with DIC and efficacy of comprehensive treatment for it. Methods Comprehensive treat-ment was conducted in 21 patients who had intensive biliary infection complicated with DIC. The he-moglutination function was monitored before and after treatment. Results Of the 21 patients, 19 were cured and 2 dead. The curative rated was 90.5 %. The hemorrhage tendency was controlled, abdomi-nal bleeding stopped, prothrombin time (PT) obviously reduced, content of fibrinogen (Fbg)in-creased, level of D-dimer and FDPs obviously dropped. Conclusion The patients who have biliary in-fection in the perioperative period are easy to suffer from DIC and the mortality is high. Early diagno-sis and comprehensive therapy, especially the application of the cryofibrinogen and heparin, are very important.

BACKGROUND:Burned rat serum has been reported as an inducer that can induce differentiation of mesenchymal stem cells into epidermal cells.
OBJECTIVE:To induce in vitro differentiation of bone marrow mesenchymal stem cells into epidermal cells that were transplanted alone or combined with inducers for the repair of skin wound defect and epidermal reconstruction.
METHODS:Under aseptic environment, rat bone marrow was harvested to culture adherent cells using low-glucose Dulbecco’s modified Eagle’s medium. Culture cells at passage 4 were confirmed as mesenchymal stem cells by flow cytometry. Bone marrow mesenchymal stem cells were induced by Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 containing 20%burned rat serum to differentiate into epidermal cells that were identified by immunohistochemistry. Wistar rat models of ful-thickness skin wounds were prepared and divided into three groups. The 5-bromo-2-deoxyuridine-labeled autologous bone marrow mesenchymal stem cells and induced bone marrow mesenchymal stem cells were coated singly onto a rat model of burn wounds, and rat models of burn wounds with no treatment served as controls. Wound contraction and regeneration of epidermal cells and skin appendages were observed.
RESULTS AND CONCLUSION:After isolation and culture of cells for 24 hours, a few of adherent cells grew as fibroblast-like cells with fusiform shape. At 16 days, cells completely covered the bottom of bottle, exhibiting a fish or reticular arrangement. After detection by flow cytometry, cells were cultured in Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 containing 20%burned rat serum, and fusiform-shaped cells gradual y became round or oval cells. Flow cytometry analysis and immunocytochemistry results showed that cells expressed keratin, which were confirmed as epidermal cells. The results show that both the bone marrow mesenchymal stem cells transplantation alone or with necessary inductor is better for skin repair than natural healing, exhibiting a faster regeneration of skin and skin appendages. Bone marrow mesenchymal stem cells are deduced preliminarily to be involved in epidermis and hair fol icle regeneration, thereby improving skin healing.

Objective To observe the cardiac function in acute brain injury patients(ABI)and the relationship between ABI and plasma neuropeptideY(NPY),and to inspect the mechanism and find the evidences for preventing cardiac impairment caused by ABI. Methods 89 patients with acute brain injury within 24 hours after the injury were divided into severe group(n =47)and mild group(n = 42)according to Glasgow Coma Scale(GCS),and 35 normal healthy adults were selected as control group.In 24 hours and 72 hours after the brain injury,all patients were examined with echocardiography to observe cardiac structure,Doppler blood flow velocity and cardiac function,and in the same time the plasma NPY were determined by radioimmunoassay.Then the results were compared with controls. Results The parameters of cardiac function such as EF、 SV.AV、CO、CI had statistical change in 24 hours and 72hours after the brain injury between severe ABI group and mild ABI group,and it also had statistical change between severe ABI group and control group(all P <0.05),but no statistical change between mild ABI group and control group(all P ＜0.05).The level of plasma NPY in ABI patients was significantly higher than that before injury,there was statistically different change between severe ABI group and mild ABI group,and it also had statistical change between severe ABI group and control group(all P＜0.05).The parameters of cardiac function was negatively correlated with the rise of plasma NPY by pearson correlation analysis(EF:r =- 0.79,P <0.01; SV:r =- 0.71,P <0.01;AV:r=-0.67,P ＜0.01 ;E/A:r =-0.63,all P ＜0.01)and(CO:r =- 0.32,P ＜0.05;CI:r =-0.35,all P ＜0.05). Conclusion The parameters of cardiac function were significantly decreased in the patients with acute brain injury,and it was closely related with the level of plasma NPY.

Objective To determine the peripheral dose ( PD) of a Trilogy accelerator under different conditions and the feasibility of PD measurement using the semiconductor diode ionization chamber. Methods In a solid water phantom, a CC13 air?filled ionization chamber and a semiconductor diode ionization chamber were used for PD measurements with different distances (13 measurement locations within 1?31 cm) , depth ( 3, 5, 15 cm) , field sizes ( 10, 20, 30 cm) , wedge ( W15, W45, VW15, VW45) , and beam energy (6, 18 MV). The relationship of PD with PDleakage and PDscat er was determined by removing the scatter phantom. Simulating the patients with cervical cancer undergoing radiotherapy, a CIRS phantom received volumetric modulated arc therapy ( VMAT) , step?shoot intensity?modulated radiotherapy ( IMRT) , and sliding?window IMRT to measure PDs of the breast, thyroid, and lens. All the data were normalized to the isocenter. Results PD was gradually reduced with the increase in distance ( 13?41% at 1 cm from the edge to 0?25% at 31 cm from the edge) . With a fixed distance from the edge of the radiation field, there was no significant difference in PD between different depths. A radiation field with a size of 30 cm had a PD about two?fold higher than that with a size of 10 cm. PD increased with the increase in the physical wedge angle and increased by 1% compared with the open field;PD decreased with the increase in the virtual wedge angle and decreased by 2?3% compared with the open field. PD decayed from 13?35% at 1 cm to 0?23% at 31 cm under 6 MV X?ray and from 11?06% at 1 cm to 0?20% at 31 cm under 18 MV X?ray. Dscat er was dominant in the regions close to the edge of radiation field and decreased from 62?45% at 1 cm to 5?71% at 25 cm. In all measurements under 6 MV X?ray, the maximum proportion difference between CC13 ionization chamber and diode ionization chamber was less than 1%. PDs of the breast, thyroid, and lens were 6?72, 2?90, and 2?37 mGy in VMAT mode, 7?39, 4?05, and 2?48 mGy in step?shoot IMRT mode, and 9?17, 4?61, and 3?21 mGy in sliding?window IMRT mode, respectively. Conclusions For the measurement of PDs, the CC13 air?filled ionization chamber and semiconductor diode ionization chamber have good consistency and feasibility under 6 MV X?ray. In clinical practice, the understanding of the relationship of PD with different radiation conditions helps to reduce the doses to organs at risk. Shielding and protective techniques can further reduce dose deposition.

Objective:To investigate the effectiveness and safety of bortezomib combined with conventional chemotherapy regimens for treatment of relapsed/refractory acute B lymphoblastic leukemia (B-ALL).Methods:Twenty patients with relapsed/refractory B-ALL treated with bortezomib combined with chemotherapy in Jiaozuo People's Hospital Affiliated to Xinxiang Medical College, Jiaozuo Coal Industry Group Central Hospital and the Second People's Hospital of Jiaozuo from September 2021 to June 2022 were collected, and their treatment response and prognosis were retrospectively analyzed.Results:The median age of the 20 patients was 49.5 years old (25.0-58.5 years old); 12 were male and 8 were female; 12 were relapsed and 8 were refractory. All patients completed 1 course of bortezomib (1.6 mg/m 2, subcutaneous injection on days 2 and 16) combined with chemotherapy. Before bortezomib treatment, there were 0 case of complete remission (CR), 7 cases of partial remission (PR) and 13 cases of non-remission (NR) in 20 patients, the objective remission rate (ORR) was 35% (7/20), and all were positive for minimal residual disease (MRD). After bortezomib treatment, there were 13 cases of CR, 3 cases of PR and 4 cases of NR, and the ORR was 80% (16/20); the MRD of all patients decreased, among which 13 cases (65%) turned to negative; the differences were statistically significant when comparing CR rate, ORR and MRD negative conversion rate before and after bortezomib treatment ( χ2 values were 65.41, 8.83 and 19.30, all P < 0.05). Four of the 20 patients developed central nervous system infiltration despite bone marrow remission, and one died from post-chemotherapy infection. Myelosuppression occurred in all patients, the incidence of infection was 90% (18/20), and the incidence of digestive system adverse effects was 75% (15/20). Conclusions:Bortezomib combined with conventional chemotherapy regimens is effective and well tolerated in the treatment of relapsed/refractory ALL, and has the potential to enable patients with multi-drug resistant relapse to overcome resistance and to achieve deep remission.

Objective To investigate the expression of adiponectin (APN) and the clinical significance in type 2 diabetic rats with cerebral ischemic reperfusion damage.Methods One hundred and four SD rats were randomly divided into two groups,including normal diet group (n=52) and diabetic diet group (n=52); middle cerebral artery occlusion was performed in some of the rats to induce ischemia reperfusion injury models.Normal diet group was then randomly divided into euglycemia group (n=8) and ischemia reperfusion group (I/R,n-44); diabetic diet group was randomly divided into diabetes groups (n=8) and diabetes complicated with ischemia reperfusion group (DM+I/R,n=44).The blood was collected to detect the APN changes from the tail vein of rats from diabetes group (n=4) and DM+I/R group (n=4) before MCAO surgery and at 3,6,24,48 and 72 h,and 7 d after reperfusion.The rest 40 rats were randomly divided into subgroups subjected to 90 min of focal ischemia followed by 3,6,24 and 72 h,and 7 d reperfusion (n=8); the neuroethology assessment was determined by Zea Longa method; morphology of brain tissue was observed by HE staining.APN expression in infarction cores was detected by immunohistochemistry and Western blotting.Results The assessment scores of DM+I/R group (2.79±0.41) were significantly higher than those of I/R group (1.27±0.45,P＜0.05).As compared with that in the I/R group,the serum APN level in the DM+I/R group was significantly decreased 3,6,24,48 and 72 h,and 7 d after reperfusion (P＜0.05).Cerebral tissue damage (cellular degeneration and necrosis) in DM+I/R group was more serious as compared with I/R group at the same reperfusion time.In the ischemic hemisphere,APN expression increased at 3 h,decreased at 6 h,and increased again till 24 h after reperfusion,and then it remained at high level up to 7 days after reperfusion.The expression of APN in DM+I/R group was significantly lower than that in the I/R group (P＜0.05).These findings were consistent with the results of Western blotting.Conclusion APN expression decreases after focal cerebral ischemia-reperfusion injury,indicating that APN plays an important role in aggravating ischemic reperfusion injury by diabetes.

Objective To analyze the failure and processing methods of helical tomotherapy multileaf collimator (MLC) and summarize relevant maintenance experience,aiming to accurately identify the faulty parts,shorten the downtime and enhance the work time.Methods The failure data of the helical tomotherapy MLC system in the past 48 months were analyzed to identify the common faulty parts,causes and processing methods.Results During the previous 48 months,the MLC failure occurred for 20 times,11 times for air compressor failure,4 times for position verification board failure,twice for leaf driver failure,twice for cushion valve failure and once for the slip of leaf position verification rod.The MLC failure was significantly correlated with the humidity of high-pressure gas.The work time of machine exerted significant effect upon the service time of MLC parts.Conclusions The structure of the helical tomotherapy MLC system is complex.The high-intensity work increases the failure rate.The humidity of high-pressure gas affects the normal operation of the MLC equipment.The faulty parts can be identified,the downtime can be reduced and the work time can be enhanced by summarizing the experience of MLC maintenance.

Objective:An investigation on the prevention and control measures taken by radiotherapy centers of various hospitals in Beijing during the COVID-19 pandemic was conducted. The experience was summarized to provide reference for further work.Methods:Electronic questionnaires were distributed to each radiotherapy center through members of the radiation oncology therapeutics branch of Beijing medical association and members of Society of Radiotherapy Specialists (Technicians) of Beijing Medical Doctors Association. Statistical analysis was performed based on the feedback results of electronic questionnaires.Results:All forty radiotherapy centers in Beijing returned the questionnaires by the end of April 10, 2020. Except for the suspension of treatment in one center due to COVID-19 pandemic, all radiotherapy centers have taken corresponding prevention and control measures and continued to carry out radiotherapy. No COVID-19 infection of patients or medical staffs occurred during this pandemic.Conclusions:During the COVID-19 pandemic, all radiotherapy centers attach great importance to optimizing the clinical process and adopt reasonable prevention and control measures. On the basis of efficient prevention and control measures, radiotherapy is delivered to fulfill the treatment demands of cancer patients.

Objective　The clinical diagnosis of head and neck tumors with multiple groups of cranial nerve palsy as the first symptom is challenging.Based on the cases,a review of literature was conducted to discussed the etiology of this rare disease.Methods　A retrospective summary of 4 patients with multiple cranial nerve palsy as the first symptom admitted to Shaanxi Provincial People's Hospital and Tangdu Hospital of Air Force Military Medical University from January 2018 to December 2021 were analyzed.Results　A case of jugular foramen paraganglioma with the 5th,7th,8th,9th and 12th cranial nerve palsy,and one case of glomus jugular tumor involving the 7th and 8th cranial nerves.Case of germinoma affected the 2th,3th,5th,6th,7th and 8th cranial nerves,and nasal skull base adenocarcinoma had the 1th,3th,4th,5th,6th,7th,8th and 12th cranial nerves paralyzed.Conclusion　Multiple cranial nerve palsy could be one of the presenting features of underlying benign or malignant tumors of the head and neck.In terms of etiological diagnosis,enough attentions should be paid to tumors.

Objective:To evaluate the clinical application of online adaptive radiotherapy based on iterative cone-beam computed tomography (iCBCT) for the pelvic malignancies.Methods:This was a prospective clinical trial of iCBCT guided online adaptive radiotherapy for pelvic malignancies in Department of Radiation Oncology, Peking Union Medical College Hospital. Clinical data of 13 patients with pelvic malignancies who received online adaptive radiotherapy from August to November, 2022 were preliminarily analyzed (2 cases of cervical cancer, 4 postoperative cervical cancer, 3 postoperative endometrial cancer, 3 bladder cancer and 1 prostate cancer). The feasibility of online adaptive radiotherapy, adaptive radiotherapy time, the frequency and magnitude of edits for organs at risk and target volume, target volume coverage and organs at risk doses were analyzed. Statistical analysis was performed by SPSS software. Data conforming to normal distribution were described by Mean±SD, and data with non-normal distribution were expressed by M ( Q1, Q3). Data with homogeneous variances were analyzed by t-test, and data with non-normal distribution or heterogeneous variances were analyzed by nonparametric test. Results:The average adaptive time was 15 min and 38 s (from acceptance of acquired CBCT scan to completion of the final plan selection). 85.4% (830/972 fractions) of influencer structures (system-defined organs adjacent to and with high impact on the generation of clinical target volume and planning target volume, primarily bladder, rectum and small intestine in pelvic neoplasms) automatically generated by artificial intelligence required no edits or minor editors, and 89.8% (491/547 fractions) of clinical target volume automatically generated by artificial intelligence required no edits or minor editors. The adapted plan was adopted in 98.5% (319/324 fractions) of radiotherapy fractions. Compared with the scheduled plan, the adapted plan showed better target volume coverage and reduced the dose of organs at risk.Conclusions:iCBCT guided online adaptive radiotherapy for the pelvic malignancies can be achieved within clinically acceptable timeslots. In addtion, better dose coverage of target volume shows the advantages of online adaptive radiotherapy.