Objective To investigate the correlation between enlarged perivascular space (EPVS) and post-stroke depression (PSD) in patients with ischemic stroke. Methods Consecutive patients with acute cerebral infarction admitted to hospital from March 2010 to March 2014 were enroled prospectively. The patients completed head MRI examination after admission and performed EPVS grading. At 3 months after symptom onset, they performed PSD assessment according to Hamilton Depression Scale (HAMD) and Classification and Diagnostic Criteria of Mental Disorders in China, 3rd edition (CCMD-3). The relationship between EPVS and PSD was analyzed. Results A total of 249 patients were enroled; including 62 patients (4. 9% ) experienced PSD at 3 months. There were significant differences in the proportions of the EPVS classification patients of the baseline National Institutes of Health Stroke Scale score ( the median [interquartile range]; 4 [3 - 6] vs. 3 [2 - 5]; Z = - 2. 950, P = 0. 003), centrum semiovale (χ2 = 14. 370, P = 0. 001), and periventricular (χ2 = 11. 590, P = 0. 003)between the PSD group and the non-PSD group. Multivariable logistic regression analysis showed that centrum semiovale EPVS grade 2 (odds ratio [OR] 3. 89, 95% confidence interval [ CI] 1. 59 - 9. 56) and grade 3 (OR 3. 28, 95% CI 1. 04 - 10. 33) were significantly correlated with PSD; periventricular EPVS grade 2 (OR 0. 72, 95% CI 0. 27 - 1. 91) and grade 3 (OR 2. 24, 95% CI 0. 68 - 7. 37) were not correlated with PSD. Conclusions Centrum semiovale EPVS is independently associated with PSD, and periventricular EPVS is not.

Objective To explore the significance of using cytologic and RT-PCR methods to examine(peritoneal) washings and peritoneal tissues of gastric cancer patients in prediction of peritoneal micrometastasis.Methods The peritoneal washings of 38 patients with gastric cancer and 5 patients with benign gastric(lesions) were collected and,at the same time,a small amount of omentum and peritoneum were removed for control.CEAmRNA expression of free cells in peritoneal washings were detected by RT-PCR method and(also) cytology of the washings were performed.Results The CEAmRNA expression rate of peritoneal washings and peritoneal tissues were 36.8%(14/38) and 39.5%(15/38)respectively.Both were more(sensitive) than that of cytologic examination 26.3%(10/38).TNM staging,depth of invasion,lymph node metastasis,and serosal involvement were related to the expression rate of CEAmRNA.Conclusions mRNA of CEA is more sensitive and specific than cytologic examination for detecting free cancer cells in peritoneal cavity.It is an effective method for detecting peritoneal micrometastases in gastric cancer patient.

Objective:To elucidate the effects of andrographolide (AG) against acute pancreatitis (AP)-associated kidney injury and explore the potential mechanism.Methods:Thirty-two C57BL/6 mice were divided into control group, AP group, AG treatment group and AG control group. In AP group, AP model was established by intraperitoneal injection of L-arginine and LPS. AG treatment group was intravenously injected with AG 8 h before the model establishment. The control group was intraperitoneally injected with an equal volume of normal saline. The AG control group was intravenously injected with AG 8 h before the intraperitoneal administration of normal saline. Venous blood of inner canthus in mice was collected, and the levels of amylase, creatinine (Scr) and urea nitrogen (BUN) in serum were detected. Pancreatic and double kidney tissues were also collected. Pancreatic myeloperoxidase (MPO) activity was detected by colorimetry. Histopathological changes of pancreas and kidneys were observed under light microscope and pathological score was evaluated. Ultra-high-performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry was used to analyze metabonomics in renal tissue.Results:Compared to the control group, the levels of amylase, Scr and BUN in serum and pancreatic MPO activity in the AP group were obviously increased [(13.78±6.01)U/L to (0.23±0.04)U/L, (79.81±24.03)μmol/L to (9.02±2.87)μmol/L, (34.76±14.53)mmol/L to (8.52±2.55)mmol/L, (16.55±4.23)U/g pro to (2.32±0.55)U/g pro]; histopathologic scores of pancreas and kidney in the AP group were also increased (2.70±0.26 to 0.20±0.12, 3.00±0.35 to 0.30±0.12), and the differences were statistically significant (all P<0.05). The levels of amylase, Scr and BUN in serum and pancreatic MPO activity in the AG treatment group were decreased than the AP group [(8.26±3.87)U/L to (13.78±6.01)U/L, (55.42±17.25)μmol/L to (79.81±24.03)μmol/L, (20.66±10.30)mmol/L to (34.76±14.53)mmol/L, (11.51±3.29)U/g pro to (16.55±4.23)U/g pro]; histopathologic scores of pancreas and kidney were also decreased in the AG treatment group than those in the AP group (1.40±0.19 to 2.70±0.26、1.70±0.26 to 3.00±0.35), and the differences were statistically significant (all P<0.05). Metabonomics analysis detected a total of 31 metabolites. Most of metabolites were involved in amino acid and fatty acid metabolism, and a few of them were also involved in glucose, nucleotide, vitamin and bile acid metabolism. Conclusions:AG exerts protective effects on AP-associated kidney injury by altering the levels of multiple metabolites.

OBJECTIVETo investigate the factors affecting survival rate in gastric cancer patients with lung metastasis.

METHODSClinicopathological and follow-up data of 64 gastric cancer patients with lung metastasis treated at the Cancer Hospital of Tianjin Medical University from January 1995 to December 2011, were retrospectively analyzed. The survival rate was calculated. Univariate and multivariate analysis were performed to find the factors affecting survival rate using Log-rank test and Cox proportional hazards model, respectively.

RESULTSThe median survival time was 7 months. The 1-, 2- and 3-year survival rates were 32.8%, 18.8% and 7.8% respectively. Univariate analysis showed that primary tumor location, type of lung metastasis, lung metastasis combined with other distant metastasis and chemotherapy were significant factors for prognosis (P<0.05). Multivariate analysis revealed that bilateral lung metastasis(HR=2.093, 95% CI: 1.092-4.014, P=0.026) and lung metastasis combined with other distant metastasis (HR=2.433, 95% CI: 1.359-4.358, P=0.003) were independent risk prognostic factors, while chemotherapy was independent protective factor(HR=0.387, 95% CI: 0.211-0.710, P=0.002).

CONCLUSIONSPrognosis of gastric cancer patients with lung metastasis is quite poor, especially those with bilateral lung involvement and extra-pulmonary metastasis. Systemic chemotherapy may improve the prognosis of these patients.

Factor Analysis, Statistical ; Humans ; Lung Neoplasms ; secondary ; Multivariate Analysis ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; Survival Rate

Objective:To demonstrate the concept of planning target volume (PTV) is not suitable for intensity proton therapy (IMPT) in lung cancer, plan differences were compared based on the concept of PTV and Internal target volume (ITV), aiming to provide clinical reference.Methods:Six patients were retrospectively selected and approved by the local ethics committee. Each of the six patients received two IMPT plans based on a synchronous accelerator model, developed by SINAP team (Shanghai Institute of Applied Physics, China Academy Science University) and commercial treatment system: one with the PTV-based robust IMPT (PTV-IMPT) plan and the other with ITV-based robust IMPT (ITV-IMPT) plan. Three beams were set in all plans, and the final dose was calculated using Monte Carlo dose algorithm. The plan quality and robustness of PTV-IMPT and ITV-IMPT plans were evaluated quantitatively.Results:Compared to the PTV-IMPT plan, ITV-IMPT plan showed better target conformity index (conformability index: 0.58 vs.0.43), better homogeneity index (homogeneity index: 0.96 vs.0.92), lower V 5Gy in normal lung tissue (13.1% vs.13.5%) and maximum dose in spinal cord (8.9 Gy vs. 9.5 Gy) as well as plan monitor unit (MU: 338 vs. 401) . In addition, ITV-IMPT plan showed more robust in target coverage (0.003-0.032 vs. 0.02-0.28), and normal lung tissue was also found a bit robust in the ITV-IMPT plan ( 0.06-0.11, 0.07-0.13). Conclusions:Compared with the PTV-IMPT plan, ITV-IMPT plan has the advantages of high planning quality, well robustness and better tumor motion mitigation. Therefore, ITV concept is recommended to be applied in the IMPT plan for lung cancer.

Objective:The purpose of current study was to evaluate the interplay effects in intensity-modulated proton therapy (IMPT) for lung cancer and compare the results of different Iso-energy layer repainting techniques in the mitigation of interplay effects.Methods:Eight patients with lung cancer who underwent 4DCT were retrospectively selected. A robust CTV-based IMPT plan was generated for each based on commercial TPS, considering patient setup errors ±5 mm, range uncertainties ±3.5%, and CTV time structure motion in 4DCT image. Monte Carlo dose engines were used for all IMPT plans in the final dose calculation. The 4D static dose (4DSD) and 4D dynamic dose (4DDD) were calculated using a hybrid deformable algorithm and simulated proton delivery system for interplay effects. An index[ΔI(ROI, DVH)] was developed to quantitatively evaluate the interplay effects. We applied Iso-energy layer repainting techniques with different numbers of repainting (3, 4, 5, 6, 7) to the robust IMPT plans and evaluated the difference in the mitigation of interplay effects based on the ΔI(ROI, DVH) index.Results:Due to interplay effects, the mean values of target coverage, conformity and homogeneity index reduced by 13.7%, 12.7% and 24.6%, respectively. The mean values of lung V 5Gy and V 20Gy improved by 0.8%, 3.4% and 2.6%. Compared to the IMPT plans without layer repainting, Multiple iso-energy layers repainting techniques improved the mean values of CTV coverage by 4.5%, 3.8%, 3.8%, 3.6% and 5.7%, respectively. The average values of lung V 20Gy reduced by 1.5%, 1.8%, 1.7%, 1.6% and 1.9%, respectively. Conclusions:In the robust CTV-based IMPT plans, the interplay effects degraded the target dose distribution but were mitigated using iso-energy layer repainting techniques. We recommended to use the layer repainting technique according to the characteristics of the patient.

Objective To compare target dosimetric distribution and normal tissue radiation between different static intensity-modulated radiation therapy (IMRT)plans and volumetric modulated arc therapy (VMAT),and to identify the best IMRT plan for lymphoma patients needed mediastinal radiation. Methods A total of 11 patients with lymphoma who received first course radiotherapy in the mediastinal region after che-motherapy in Cancer Hospital & Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from March 2017 to January 2019 were included in the study. There were 8 males and 3 fe-males,2 patients were in Ann Arbor stage Ⅰ-Ⅱ,and 9 cases in Ⅲ-Ⅳ stage. There were 6 patients with Hodgkin lymphoma (HL)and 5 patients with non-Hodgkin lymphoma (NHL). Patients with HL and NHL were given prescript doses of 36 Gy and 50 Gy,respectively. Three plans were designed for each patient:static 5F-IMRT,7F-IMRT and VMAT plan. The target dosimetric distribution,normal tissue radiation dose,and effi-ciency of each plan were evaluated. Results The mean conformity index (CI)and homogeneity index (HI) values of plan target volume (PTV)in 5F-IMRT,7F-IMRT,VMAT plan were 0. 64 ± 0. 06,0. 67 ± 0. 05, 0. 76 ± 0. 04 (F = 17. 045,P < 0. 001)and 1. 07 ± 0. 01,1. 07 ± 0. 01,1. 09 ± 0. 01 (F = 9. 258,P =0. 001),respectively. VMAT showed significantly better CI than two static IMRT plans (both P < 0. 001),but worse HI (both P < 0. 001). The lungs low dose irradiation volume (V (V 5 )and high dose irradiation volume 30 )in 5F-IMRT,7F-IMRT,VMAT plan were (43. 98 ± 7. 77)％,(42. 71 ± 4. 98)％,(55. 92 ± 8. 16)％(F = 8. 281,P = 0. 001)and (8. 19 ± 2. 97)％,(8. 25 ± 2. 87)％,(7. 53 ± 3. 16)％ (F = 0. 140,P =0. 870),respectively. The volume of low dose irradiation in lungs of VMAT plan was significantly higher than 5F-IMRT and 7F-IMRT plans (both P < 0. 001),while high dose volume was no significant difference. The left and right breast low dose irradiation volume (V 4 )in 5F-IMRT,7F-IMRT and VMAT plan were (24. 29 ± 8. 14)％,(23. 87 ± 7. 70)％,(80. 17 ± 22. 92)％ (F = 14. 505,P = 0. 005)and (22. 12 ± 13. 28)％, (21. 13 ± 13. 01)％,(81. 77 ± 20. 76)％ (F = 13. 938,P = 0. 006),respectively. VMAT showed signifi-cantly higher breast low dose irradiation volume than static IMRT plan (both P < 0. 05). The number of monitor units and treatment time in 5F-IMRT,7F-IMRT,VMAT plan were (1622 ± 281)MU,(1729 ± 286)MU, (411 ± 75)MU (F = 105. 277,P < 0. 001)and (6. 79 ± 0. 93)min,(7. 42 ± 0. 95)min,(4. 98 ± 0. 00)min (F = 29. 545,P < 0. 001),respectively. VMAT showed significantly less monitor units than static IMRT (both P < 0. 001)and shorter treatment time (both P < 0. 001). Conclusion For lymphoma patients who have the indication of mediastinal radiotherapy,VMAT is highly efficient and has no definite dose advan-tage,the static 5F-IMRT or 7F-IMRT plan has good conformal and uniform target area,and some organs at risk exposure is even lower.

Objective To investigate the dose level of pediatric CT scan in one hospital, and to provide recommendations for optimized scanning. Methods The CT scan data of children were collected from this hospital to analyze the differences in typical dose values and typical scanning parameters between different age groups and different scanning parts. Results The sample size was >10 for routine cranial scan, routine maxillary sinus scan, and routine chest scan in each age group, and the 1-year-old group and the 5-year-old group had the same kV, mA, and CTDIvol values of routine cranial scan and maxillary sinus scan, but with relatively great differences in the parameters of chest scan. Conclusion Scanning parameters in this hospital can be further optimized, and optimization measures should be adopted continuously.

Objective:To investigate the prevalence of thyroid nodules (TN) among people undergoing physical examination in Taiyuan City, and evaluate the impact of hyperuricemia (HUA) on the risk of TN.Methods:Using a prospective design, a total of 42 966 people who underwent routine physical examination at Shanxi Shangning Health Examination Center from October 2020 to October 2021 were selected as subjects and divided into the HUA group ( n = 7 235) and the non-HUA group ( n = 35 731) based on the serum uric acid levels. The propensity score matching (PSM) method was used to balance the confounding factors between groups, and logistic regression was used to analyze the impact of HUA on the risk of TN. Results:The total detection rate of TN in the physical examination population was 55.6% (23 907/42 966). The detection rate of TN in females [61.0% (15 011/24 618)] was higher than that in males [48.5% (8 896/18 348)], and the difference was statistically significant (χ 2 = 664.55, P < 0.001). A total of 2 438 pairs of matching data were obtained after PSM, and the distribution of confounding factors in HUA and non-HUA groups reached equilibrium (the absolute values of standardized differences < 0.10). Logistic regression analysis before PSM showed that HUA was a protective factor for the incidence of TN in general population and males [odds ratio ( OR) = 0.696, 0.817, 95% confidence interval ( CI): 0.661 - 0.732, 0.768 - 0.868], while HUA was a risk factor for the incidence of TN in females ( OR = 1.370, 95% CI: 1.192 - 1.574). After PSM, HUA was not a influencing factor for the incidence of TN in general population and males ( P > 0.05), but it was still a risk factor in females for the onset of TN ( OR = 1.373, 95% CI: 1.014 - 1.858). Conclusion:In the physical examination population in Taiyuan City, HUA is an independent risk factor for TN in females.

Objective : To analyze the overall survival( OS) of sequential osimertinib treatment in patients with epidermal growth factor receptor(EGFR) exon 20 T790M mutant advanced non⁃small cell lung cancer(NSCLC) and risk factors of the efficacy of sequential osimertinib treatment. Methods : The data of 138 advanced NSCLC patients with acquired EGFR exon 20 T790M mutation who took sequential osimertinib as second⁃line treatment. KaplanMeier variable was used for survival analysis. The Log⁃rank method was used for univariate analysis. The COX risk regression model was used for multivariate analysis. The survival status and influencing factors of patients treated with sequential osimertinib were analyzed. Results : At the last follow⁃up , 99 of the 138 patients died. Median progression free survival (PFS1)of first⁃line of first⁃ or second⁃generation epidermal growth factor receptor tyrosine kinase inhibitors(EGFR⁃TKIs) was 11 months (95% CI: 10. 1 - 11. 9) ; median PFS2 of osimertinib was 10 months (95% CI: 8. 5 - 11. 5) ; The median PFS with sequential osimertinib treatment was 24 months(95% CI: 21. 7 -26. 3) , the median OS was 32 months(95% CI: 28. 9 - 35. 1) . In univariate and multivariate analysis , PFS1 was an independent prognostic factor for PFS and OS(P < 0. 001) . Conclusion Sequential osimertinib treatment for advanced NSCLC patients with acquired EGFR exon 20 T790M mutation achieved good PFS(24 months) and OS (32 months) .