Objective To study the physical characteristics of the OPEN stereotactic body radiotherapy system for the clinical application. Methods The 0. 125cc ioniztion chamber, 160 mm polystyrene sphere model,Gafchromic EBT2 films and IBA film analysis software were used to evaluated the focus position tolerance,dose rate,repeatability,linear relation,penumbra and composite error of the OPEN stereotactic body gamma knife. We used the DTA method to verify the accuracy of dose distribution between the plans and measured value. Resualts The focus error was 0. 36 mm,max dose rate tolerance 3%,linear relation error 2%,repeatability error 0. 3%,composited error 2. 5 mm. There was 90% pass rate when the distance away from test point was less than 2 mm and the dose error was set less than 5 % . Conclusions Parts of the test resualts were similar to the head gamma knife national protocal of OPEN stereotatic body gamma knife. The deliver dose distribution can meet the clinic need.

OBJECTIVETo analyze the results of postoperative radiotherapy with electronic beam for patients with keloids in our hospital.

METHODSFrom September 2006 to May 2009, radiotherapy was given within 24 hours after operation in 53 keloid patients. With single vertical field irradiation, 6-12 Mev electronic beams of Linear Accelerator were selected for different incision depth in different sites. The field size was 1.0 cm (range: 0.5-2.0 cm) away from both incision ends and 1.25 cm (range: 0.75-2.50 cm) away from incision laterally. The radiation was given daily with median treatment course of 4 days (range: 3-21 days) at 3.5 Gy/Fx to a median total dose of 14 Gy (range: 8-20 Gy). SPSS 21. 0 was used for analysis.

RESULTSAll postoperative incisions healed in one stage, the median follow-up was 34 months (range: 18-63 months). The overall local control rate was 79.7%. For patients who received the dose of more than 14 Gy versus less than 14 Gy, the local control rate was 81.6%, 75.2%, respectively (P > 0.05). For male and female, the 3 year local recurrence rate were 45.3%, 9.9% respectively (P = 0.008). Multivariate analysis showed that the sex (male versus female) was an independent prognostic factor (P = 0.036).

CONCLUSIONSurgery combined with electronic beam irradiation is a rather effective way to treat keloids. The local control rate would have a better trend if the total dose was higher than 14 Gy. Sex is an independent prognostic factor.

Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Keloid ; radiotherapy ; Male ; Middle Aged ; Postoperative Care ; Treatment Outcome ; Young Adult

Background Acute lymphoblastic leukemia (ALL) and chemotherapy can cause immune imbalance,and gaseous molecule hydrogen sulfide (H2S) can participate in the process of immune response.This study aimed to investigate the immune regulation of H2S in pediatric ALL.Methods Children (n=78) with ALL admitted during 2010-2013 were included in this study.Two blood samples were collected in period of before chemotherapy,bone marrow remission and two days after chemotherapy,respectively.Serum contents of H2S and cytokines,including interleukin-1β (IL-13),interleukin-2 (IL-2),interferon-γ (IFN-γ),tumor necrosis factor (TNF-α),interleukin-4 (IL-4),interleukin-6 (IL-6),interleukin-10 (IL-10) and macrophage inflammatory protein-1α (MIP-1a),were detected using ELISA method.Stepwise regression was used to analyze the correlation between H2S and cytokines.Furthermore,human Jurkat cells were cultured in vitro,and nucleoprotein of Jurkat cells and peripheral blood mononuclear cells (PBMCs) were collected,contents of cystathionine γ-lyase (CSE) and certain cytokines were measured by Western blotting.Results Serum concentrations of H2S,IL-13,IL-6,IL-10 and MIP-1α in children with ALL were increased significantly (P ＜0.01),while concentrations of IL-2,TNF-α,IFN-γ and IL-4 decreased obviously (P ＜0.01).In patients after chemotherapy,concentrations of H2S and IL-10 were decreased significantly (P ＜0.05),but IL-4 and IFN-γ concentrations increased markedly (P ＜0.05).At remission stage,H2S,IL-13,IL-4,IL-6,IL-10 and MIP-1α concentrations were further decreased markedly (P ＜0.05),but concentrations of IL-2,TNF-α and IFN-γ increased again (P ＜0.05).Protein contents of CSE,IL-10,IL-4 and IL-2 of PBMCs also increased markedly in children with ALL.Moreover,changes of CSE protein contents of PBMCs were consistent with serum H2S contents,and there were significant correlation between H2S and certain cytokines based on stepwise regression analysis.Furthermore,compared with those of PBMCs group,in vitro study indicated that Jurkat cells of H2S group expressed IFN-γ,IL-10,IL-4 and IL-2 protein increased obviously (P ＜0.05),while IL-4,IL-2 and CSE expression of PPG group decreased markedly (P ＜0.05).Conclusion Gaseous molecule H2S might participate in the process of immune regulation in pediatric ALL through modulating transcription and expression of cytokines.

Background Bacterial inflammation is a common complication in patients with leukemia,and sulfur dioxide (SO2) is a bioactive molecule in modulating Gram-negative bacilli infection.This study aimed to examine the changes in SO2,nuclear factor-κB (NF-κB),and interleukin-8 (IL-8) levels in pediatric acute lymphoblastic leukemia (ALL) with Gram-negative bacterial inflammation.Methods Fifty-five ALL children were enrolled in this study,including 30 males and 25 females,aged 3-13 years,and the median age was 7.8 years.All these children who accepted chemotherapy for ALL were divided into the control group (before chemotherapy),the infection group (after chemotherapy with infection),and the recovery group (the infection was controlled after 1 week).The serum level of SO2 was detected using high performance liquid chromatography with fluorescence assay,and NF-κB and IL-8 levels were measured by enzyme-linked immunosorbent assay (ELISA).Human THP-1 cells were cultured,induced,and differentiated into macrophages,which were divided into five groups and each group was cultured with different stimulators:lipopolysaccharide (LPS) group,LPS+L-aspartate-β-hydroxamate (HDX) group,LPS+SO2 group,SO2,and control groups.NF-κB level and IL-8 protein contents by ELISA were examined in each group.Results In comparison with those of the control group,levels of serum SO2,NF-κB,and IL-8 of the infection group were significantly increased (P ＜0.05),while those of the recovery group were significantly decreased (P ＜0.05).A positive correlation was found between levels of serum SO2 and intracellular NF-κB/IL-8,and the correlation coefficients were 0.671 and 0.798 (P ＜0.05),respectively.According to the results found in human THP-1 cells,levels of NF-κB and IL-8 in LPS group were significantly increased compared with those of the control group (P ＜0.05); when compared with those in LPS group,levels of NF-κB in LPS+HDX group further increased significantly (P ＜0.05); however,the NF-κB levels of LPS+SO2 group decreased significantly (P ＜0.05).Conclusion SO2 may play an anti-inflammatory role during the process of inflammation by inhibiting the activation and transcription of NF-κB.

Objective:To evaluate the safety and efficacy of a dedicated neonatal-infant brain 0.35 T MRI system.Methods:A dual-center controlled clinical trial was conducted with single-arm objective performance criteria. From June to July 2020, sixty-six infants aged 0-12 (6.3±3.4) months were recruited from Children′s Hospital of Soochow University and the First People′s Hospital of Lianyungang prospectively. All infants underwent brain MRI with a dedicated neonatal-infant 0.35 T brain MRI system, using the dedicated two-channel transceiver head coil. MRI protocol included spin echo T 1WI, fast spin echo T 2WI, fluid attenuated inversion recovery, diffusion weighted imaging and 3D gradient echo sequence. MRI sequences were set with three orientations (axial, sagittal and coronal). Each case received at least two scanning planes and two scanning sequences. Five-point Likert scoring system was used to evaluate the image quality of acquired images, and the target value was set as at least 3 points per image. The temperature, heart rate and breathe of the infants were recorded before and after MRI; the acoustic noise of the MRI system was measured during the scanning process; and the adverse reactions were recorded if presented. Results:Five infants successfully completed their examination during non-sedated sleep in a single attempt, and 61 infants after sedation with chloral hydrate. Based on MRI-based five-point Likert scoring system, 41 cases achieved a score of 5, 21 cases with a score of 4 and 4 cases with a score of 3. Cases with score of 3 was due to movement of the infants during the scan, which resulted in motion related artifacts. The vital signs of all infants showed stable before and after imaging, with heart rate of (126.8±12.9) beats per minute, breathe of (38.2±6.8) times per minute. It was found that 47 cases showed no sign of temperature raise after brain MRI, 15 cases had less than 0.3 ℃ raise and 4 cases had 0.3 ℃ to 0.5 ℃ raise. The noise recorded during the scanning process was (57.5±1.8) dB(A). One case had mild diarrhea on the day of MR scan, and the symptoms disappeared on the second day without treatment; no adverse reactions were found for the rest subjects.Conclusion:Dedicated neonatal-infant 0.35 T brain MRI system allows data acquisition with high safety and excellent image quality, which has potentials in the clinical applications.

Objective:To evaluate the effectiveness and safety of sofosbuvir/velpatasvir (SOF/VEL) with or without ribavirin in the treatment of patients diagnosed with chronic hepatitis C (CHC) and chronic kidney disease (CKD).Methods:From June 2018 to May 2022, a total of 75 patients with CHC and CKD, and treated with SOF/VEL±ribavirin at the Kunming Third People′s Hospital were enrolled in this study. The basic information of patients were collected. Assessments of renal function, liver function, virologic response rate and adverse events were conducted at baseline, four weeks and 12 weeks of treatment and 12 weeks after treatment withdrawal. Wilcoxon rank sum test and Kruskal-Wallis rank sum test were used for statistical analysis.Results:Among the 75 patients, 51 cases(68.0%) were classified as CKD stage 2, 12 cases (16.0%) as CKD stage 3, four cases (5.3%) as CKD stage 4, eight cases (10.7%) as CKD stage 5. Additionally, 26 cases (34.7%) were classified as HCV type 3a, while 37 cases (49.3%) were classified as type 3b. Among the patients, 51 cases (68.0%) had cirrhosis, including 15(20.0%) compensated cirrhosis and 36(48.0%) decompensated cirrhosis. Twelve weeks after treatment withdrawal, there was a statistically significant improvement in the estimated glomerular filtration rate (eGFR) compared to baseline (81.76(60.94, 94.34) mL/(min·1.73 m 2) vs 70.99(52.86, 82.38) mL/(min·1.73 m 2), Z=8.12, P=0.040). From baseline to 12 weeks after treatment withdrawal, eGFR of patients with CKD stage 2 and stage 3 were both gradually increased, with statistical significance ( H=8.91 and 8.03, respectively, both P<0.05). For CKD stage 2 patients, eGFR increased from 78.82(70.98, 84.80) mL/(min·1.73 m 2) to 86.94 (75.91, 96.01) mL/(min·1.73 m 2), while CKD stage 3 patients had an increased from 51.24 (45.92, 53.37) mL/(min·1.73 m 2) to 64.58 (44.54, 74.34) mL/(min·1.73 m 2). Renal function was improved to CKD stage 1 in 21 patients (28.0%). Compared to baseline, CKD stage 2 patients exhibited a decrease of aspartate aminotransferase to platelet ratio index 12 weeks after treatment withdrawal, and alanine aminotransferase and aspartate aminotransferase levels were also significantly improved with statistical significance ( Z=8.03, 21.57 and 43.74, respectively, all P<0.05). The rate of sustained virological response (SVR)12 at 12 weeks after treatment withdrawal was 98.7%(74/75). Among these cases, 51 patients in CKD stage 2, 11 patients in CKD stage 3, 12 patients in CKD stage 4 and stage 5 reached SVR12. Adverse events occurred in 32 patients (42.7%), including 18 cases of mild hemolytic anemia, four cases of skin itching, three cases of rash, two cases of chest tightness, and five cases of fatigue. Conclusions:SOF/VEL with or without ribavirin for the treatment of patients with CHC and CKD has good effectiveness and safety. The renal function, liver function and liver fibrosis degree have been improved after antiviral treatment.

Objective To evaluate the clinical efficacy of a rapid 3D-printed patient-specific osteotomy guide in knee replacement surgery,and provide guidance for its widespread clinical application.Methods A total of 80 patients with end-stage knee osteoarthritis who had undergone Total Knee Arthroplasty(TKA)were selected and randomly divided into two groups.The first group comprised 40 cases(40 knees)that underwent traditional TKA,while the second group consisted of 40 patients(40 knees)in the 3D-printed osteotomy guide group.Various parameters,including surgery duration,intraoperative blood loss,time to ambulation after surgery,mechanical axis angle between femur and tibia post-surgery,Visual Analog Scale(VAS)score,Hospital for Special Surgery(HSS)knee score,Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score,range of motion(ROM)of the knee,and other indicators were analyzed separately for both groups.Statistical analyses were conducted.Results All the patients underwent surgery smoothly and were followed up for 3～12 months.In com-parison to the traditional osteotomy guide group,the 3D-printed osteotomy guide group demonstrated significantly shorter surgery duration(P<0.05),reduced intraoperative blood loss,earlier time to first ambulation after surgery(P<0.05),lower postoperative VAS score,and smaller mechanical axis angle between the femur and tibia after surgery(P<0.01).At 6 months post-surgery,both groups showed significantly improved KSS scores compared to preoperative values(P<0.01).The KSS score of the 3D-printed guide group was higher than that of the traditional surgical guide group at 6 months after surgery(P<0.05),but there was no statistical difference in KSS scores between the two groups(P>0.05).WOMAC scores for both groups decreased over time at 3 and 6 months post-surgery compared to preoperative scores(P<0.05).At these time points,WOMAC scores were lower in the 3D-printed guide group than in the traditional osteotomy guide group(P<0.05).One case of hematocele and infection occurred in the traditional osteotomy guide group;however,successful discharge was achieved following re-debridement while preserving the prosthesis.None of the surgical patients experienced complications such as neurovascular injury,deep vein thrombosis,prosthesis loosening or periprosthetic fractures.Conclusion Compared to conventional total knee arthroplasty(TKA)surgery,the utilization of a rapid 3D-printed osteotomy guide for knee replacement presents several advantages,including reduced surgical operation duration,minimal intraoperative blood loss,precise and expeditious osteotomies,accelerated postoperative recovery,and heightened patient satis-faction during medical consultations.Notably,its clinical efficacy surpasses that of traditional approaches.

BACKGROUNDBacterial inflammation is a common complication in patients with leukemia, and sulfur dioxide (SO2) is a bioactive molecule in modulating Gram-negative bacilli infection. This study aimed to examine the changes in SO2, nuclear factor-κB (NF-κB), and interleukin-8 (IL-8) levels in pediatric acute lymphoblastic leukemia (ALL) with Gram-negative bacterial inflammation.

METHODSFifty-five ALL children were enrolled in this study, including 30 males and 25 females, aged 3-13 years, and the median age was 7.8 years. All these children who accepted chemotherapy for ALL were divided into the control group (before chemotherapy), the infection group (after chemotherapy with infection), and the recovery group (the infection was controlled after 1 week). The serum level of SO2 was detected using high performance liquid chromatography with fluorescence assay, and NF-κB and IL-8 levels were measured by enzyme-linked immunosorbent assay (ELISA). Human THP-1 cells were cultured, induced, and differentiated into macrophages, which were divided into five groups and each group was cultured with different stimulators: lipopolysaccharide (LPS) group, LPS+L-aspartate-β-hydroxamate (HDX) group, LPS+SO2 group, SO2, and control groups. NF-κB level and IL-8 protein contents by ELISA were examined in each group.

RESULTSIn comparison with those of the control group, levels of serum SO2, NF-κB, and IL-8 of the infection group were significantly increased (P < 0.05), while those of the recovery group were significantly decreased (P < 0.05). A positive correlation was found between levels of serum SO2 and intracellular NF-κB/IL-8, and the correlation coefficients were 0.671 and 0.798 (P < 0.05), respectively. According to the results found in human THP-1 cells, levels of NF-κB and IL-8 in LPS group were significantly increased compared with those of the control group (P < 0.05); when compared with those in LPS group, levels of NF-κB in LPS+HDX group further increased significantly (P < 0.05); however, the NF-κB levels of LPS+SO2 group decreased significantly (P < 0.05).

CONCLUSIONSO2 may play an anti-inflammatory role during the process of inflammation by inhibiting the activation and transcription of NF-κB.

Adolescent ; Bacterial Infections ; blood ; metabolism ; Cell Line ; Child ; Child, Preschool ; Female ; Humans ; Inflammation ; blood ; metabolism ; Interleukin-8 ; blood ; Male ; NF-kappa B ; blood ; metabolism ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; blood ; metabolism ; Sulfur Dioxide ; blood

BACKGROUNDAcute lymphoblastic leukemia (ALL) and chemotherapy can cause immune imbalance, and gaseous molecule hydrogen sulfide (H2S) can participate in the process of immune response. This study aimed to investigate the immune regulation of H2S in pediatric ALL.

METHODSChildren (n = 78) with ALL admitted during 2010-2013 were included in this study. Two blood samples were collected in period of before chemotherapy, bone marrow remission and two days after chemotherapy, respectively. Serum contents of H2S and cytokines, including interleukin-1β (IL-1β), interleukin-2 (IL-2), interferon-γ (IFN-γ), tumor necrosis factor (TNF-α), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10) and macrophage inflammatory protein-1α (MIP-1α), were detected using ELISA method. Stepwise regression was used to analyze the correlation between H2S and cytokines. Furthermore, human Jurkat cells were cultured in vitro, and nucleoprotein of Jurkat cells and peripheral blood mononuclear cells (PBMCs) were collected, contents of cystathionine γ-lyase (CSE) and certain cytokines were measured by Western blotting.

RESULTSSerum concentrations of H2S, IL-1β, IL-6, IL-10 and MIP-1a in children with ALL were increased significantly (P < 0.01), while concentrations of IL-2, TNF-α, IFN-γ and IL-4 decreased obviously (P < 0.01). In patients after chemotherapy, concentrations of H2S and IL-10 were decreased significantly (P < 0.05), but IL-4 and IFN-γ concentrations increased markedly (P < 0.05). At remission stage, H2S, IL-1β, IL-4, IL-6, IL-10 and MIP-1α concentrations were further decreased markedly (P < 0.05), but concentrations of IL-2, TNF-α and IFN-γ increased again (P < 0.05). Protein contents of CSE, IL-10, IL-4 and IL-2 of PBMCs also increased markedly in children with ALL. Moreover, changes of CSE protein contents of PBMCs were consistent with serum H2S contents, and there were significant correlation between H2S and certain cytokines based on stepwise regression analysis. Furthermore, compared with those of PBMCs group, in vitro study indicated that Jurkat cells of H2S group expressed IFN-γ, IL-10, IL-4 and IL-2 protein increased obviously (P < 0.05), while IL-4, IL-2 and CSE expression of PPG group decreased markedly (P < 0.05).

CONCLUSIONGaseous molecule H2S might participate in the process of immune regulation in pediatric ALL through modulating transcription and expression of cytokines.

Child ; Child, Preschool ; Cystathionine gamma-Lyase ; blood ; Female ; Humans ; Hydrogen Sulfide ; blood ; Interferon-gamma ; blood ; Interleukin-10 ; blood ; Interleukin-1beta ; blood ; Interleukin-2 ; blood ; Interleukin-4 ; blood ; Interleukin-6 ; blood ; Leukocytes, Mononuclear ; metabolism ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; blood ; Tumor Necrosis Factor-alpha ; blood