BACKGROUND:Salvianolic acid B can inhibit cell damage induced by H2O2,effectively remove excess reactive oxygen species,and exert antioxidant properties.It has been used in the treatment of many diseases.However,there are relatively few studies on the role and mechanism of salvianolic acid B in intervertebral disc degeneration. OBJECTIVE:To observe the effect and mechanism of salvianolic acid B on oxidative stress-induced intervertebral disc degeneration by using gelatin methacryloyl hydrogel as a carrier through the in vitro cell experiment and the in vivo animal experiment. METHODS:The gelatin methacryloyl hydrogel(drug-loaded hydrogel)loaded with salvianolic acid B was prepared.(1)In vitro cell experiment:The lumbar nucleus pulposus cells of adult SD rats were isolated and extracted,and passage 3 nucleus pulposus cells were selected and divided into groups:Group A was added complete medium.In group B,a complete medium containing H2O2 was added.Group C was inoculated on methylacrylylated gelatin hydrogel and added with a complete medium containing H2O2.Group D was inoculated on methyl acrylyl gelatin hydrogel loaded with salvianolic acid B and added into a complete medium containing H2O2.The E group was inoculated on the methylacrylyl gelatin hydrogel loaded with salvianolic acid B,and the complete medium containing H2O2 and the complete medium containing TLR4 signaling pathway inhibitor were added.Cell proliferation,oxidative stress,inflammatory response,gene expression of cell matrix-associated proteins and the protein expression of TLR4/nuclear factor-kB signaling pathway were detected.(2)Animal in vivo experiment:Sixty adult SD rats were randomly divided into normal group,acupuncture group,acupuncture + salvianolic acid group,acupuncture + hydrogel group and acupuncture + loading potion gel group,with 12 rats in each group.The last four groups were treated with acupuncture to establish models of intervertebral disc degeneration and then injected with normal saline,salvianolic acid B solution,non-drug loaded gel and drug-loaded gel in turn.Imaging examination and pathological observation were performed 4 weeks after surgery. RESULTS AND CONCLUSION:(1)In vitro cell experiment:Compared with group A,the cell proliferation was decreased;the oxidative stress reaction and inflammation reaction were enhanced;the expression of extracellular matrix degrading enzymes(matrix metalloproteinase 3,matrix metalloproteinase 13,ADAMTS4,ADAMTS5)was increased in group B(P<0.05),and the synthesis of extracellular matrix(type Ⅱ collagen,proteoglycan)was decreased(P<0.05).The protein expression of the TLR4/nuclear factor-kB signaling pathway was increased(P<0.05).Compared with group B,the cell proliferation of groups D and E was increased,the oxidative stress response and inflammatory response were weakened,and the expression of extracellular matrix degrading enzymes(matrix metalloproteinase 3,matrix metalloproteinase 13,ADAMTS4,ADAMTS5)was decreased(P<0.05),and the synthesis of extracellular matrix was increased(P<0.05).The protein expression of TLR4/nuclear factor-kB signaling pathway was decreased(P<0.05),and the effect was more significant in group E.(2)Animal in vivo experiment:4 weeks after surgery,intervertebral disc height index,index of MRI and pathological and histological grading of the intervertebral disc had improved significantly in the acupuncture+drug-loaded hydrogel group,and simply injecting hydrogel or salvianolic acid B solution can to a certain extent improve the intervertebral disc degeneration,but they are not as good as the injection of the drug-loaded hydrogel.(3)It is concluded that gelatin methacryloyl hydrogel loaded with salvianolic acid B can inhibit oxidative stress and inflammation in the degenerated intervertebral disc tissue,inhibit the degradation of extracellular matrix,and alleviate the process of intervertebral disc degeneration,which may be accomplished by inhibiting the TLR4/nuclear factor-kB signaling pathway.

Objective:To systematically review thrombosis risk prediction models associated with peripherally inserted central venous catheter (PICC) in adults and provide a basis for the clinical application of these models and the development of subsequent models.Methods:Databases such as CNKI, Wanfang, VIP, PubMed, CINAHL, Web of Science, and Ovid were searched to collect studies on thrombosis risk prediction models related to adult PICC, covering all entries from the inception of the databases until December 31, 2022. Two researchers independently screened the literature, extracted data, and assessed the risk of bias.Results:Nineteen studies were included. D-dimer was the most common predictive factor; only five studies underwent external validation, and six studies evaluated model calibration. All included studies exhibited high risk of bias, primarily due to methodological deficiencies in model development and validation processes; the combined area under the receiver operating characteristic curve for nine models was 0.80 (95% Confidence Interval: 0.75-0.85) .Conclusions:Research on thrombosis risk prediction models related to adult PICC is still in its developmental stage. Most of the known models perform well with comprehensive and easily obtainable predictive factors, yet they exhibit methodological shortcomings. Future research should focus on improving the methodological quality and external validation during model development and validation processes.

Lymphatic leakage and lymphatic cysts are common complications after radical resection of middle- and high-risk prostate cancer. There are many treatment methods but the effect is not accurate. This article reports two patients who were diagnosed by lipiodol lymphangiography under ultrasound guidance and used a mixture of n-butyl cyanoacrylate and lipiodol to embolize lymphatic leakage. Among them, one patient achieved success after one session of interventional embolization. Another patient achieved success after 3 interventions and embolization. Two patients had no complications related to lymphatic interventional therapy, and no lymphatic leakage recurred during the 3-month follow-up. Ultrasound-guided lymphangiography and lymphatic embolization through the inguinal lymph nodes are a feasible option for the treatment of refractory lymphoma leakage

Objective:To summarize the experience of Bacillus Calmette-Guerin(BCG) in the treatment of bladder cancer secondary to renal transplantation.Methods:The clinical data of 5 patients who underwent BCG bladder irrigation after secondary bladder cancer after kidney transplantation in Tianjin First Central Hospital from January 2015 to December 2019 were analyzed. There were 1 male and 4 female cases. During the period of immunosuppression after transplantation, 1 case developed secondary high-level non-muscular invasive bladder cancer (NMIBC), 3 cases developed secondary low-grade NMIBC, and 1 case developed secondary glandular cystitis (4 cases). The mean age of the 5 patients with secondary bladder cancer was 59.7±4.0 years. Case one with high level NMIBC was treated with transurethral resection of bladder tumor (TURBT) and postoperative irrigation of epirubicin. Case 3 and 5 with low-level NMIBC accepted regular postoperative irrigation of gemcitabine. No irrigative therapy was performed in case 2. Bladder cancer recurred in case 1, 2, 3 and 5 after 20.1±9.7 months. TURBT was observed in all the 4 patients, among which 3 were of high grade NMIBC and 1 was of low grade NMIBC. Four patients were irrigated with BCG 2 weeks after operation. Postoperative pathology indicated low-level NMIBC in case 4, and BCG was irrigated 2 weeks after the operation. During perfusion therapy, immunosuppressive agents were continued.Results:During BCG perfusion, 4 of the 5 cases showed BCG related local inflammation, among which 2 cases presented symptoms of bladder irritation, 1 case presented hematuria, and 1 case presented hematuria with low fever. Patients with frequent urination, pain in urine, hematuria and other symptoms improved after drinking plenty of water, taking bed rest and taking levofloxacin (0.5g/ day ×7 days). Patients with low fever were treated with antipyretic treatment. No antituberculous agents were used prophylactically during BCG perfusion. There were no symptoms of tuberculosis infection or sepsis. The function of transplantated kidney was normal and no tendency of rejection. The 5 patients were followed up for 7-24 months, 1 patient was lost to follow-up after 7 months of BCG bladder perfusion, and no tumor recurrence or metastasis was found in 5 patients during the follow-up.Conclusions:The use of immunosuppressive agents does not reduce the biological activity of BCG, and BCG does not increase the risk of systemic toxicity or affect the function of transplanted kidneys in immunocompromised patients. BCG is a treatment option for bladder cancer secondary to renal transplantation.

Nephron sparing surgery ( NSS ) has become the standard treatment of small renal cancer . NSS have the similar curative effect compared with radical nephrectomy and preserve the kidney fuction. However, positive surgical margins after NSS is increasing and has attracted more and more attention. We will discuss positive surgical margins related factors and how to reduce the positive surgical margins in this review.

Objective To investigate a system for the detection of the acoustic signal created by clinical proton and carbon ion Bragg-peaks (BPs).Methods An acoustic detector was attached to water phantoms downstream of the beam.The water-equivalent depth of this phantom was measured by a peakfinder (PTW,Siemens,Germany) using high energy proton beams.By maintaining the same particle number,either the BP to detector distance (BTD) or beam intensity was changed to investigate their relationships with the magnitude of acoustic signal.By moving the beam spot in lateral directions,the full width at half maximums (FWHMs) of BPs was measured and compared.Results The detected acoustic signal created by beam on or beam off could represent the magnitude of signal,which was proven by a statistical analysis.The magnitude of acoustic signals created by proton BPs were inversely proportional to BTD,but proportional to intensities.The measured FWHM of 125.43 MeV proton BP was 11.7％ larger than data from the treatment planning system (TPS).Carbon ion showed similar result whereas the measured FWHM of 178.89 MeV/u carbon ion BP was 45.6％ larger than the data from TPS.The BTDs could be more than 67.7 mm while maintaining enough magnitude of acoustic signal.Conclusions This acoustic detection system can detect the acoustic waves from clinical proton and carbon ion BPs.However,further investigation is ongoing to decrease the noise.

Objective To establish an accurate simulation model for proton scanning beam using Monte Carlo (MC) code.Methods The MC model of proton scanning beam treatment nozzle was established by using MC code FLUKA combined with the geometric structure of the treatment nozzle in Shanghai Proton and Heavy Ion Center (SPHIC).The MC beam model was established through the simulation of the integrated depth dose distribution (IDD) in water and the lateral profile in air at the isocenter points.The model was used to simulate the depth and lateral dose profile of Spread Out Bragg Peak (SOBP) of proton beam.The calucated result were compared with TPS calculation values.Results For the distal R90,the deviations of simulation and measurement at all energies were less than 0.5 mm.For distal fall off (R80-20),the deviations between simulation and measurement at each energy were within 0.1 mm.The biggest difference between measurement and simulation of the proton beam spot size was within 0.45 mm.The result of simulation and TPS calculation of proton SOBP matched well,with the γ index pass rate being higher than 90％ (Criteria:2 mm,2％).Conclusions The MC code FLUKA can be used to model the nozzle of scanning proton beam,which can meet the clinical requirements and accurately simulate the proton beam transport in material.After construction and verification on the basis of measurement,this model can be used as a dose verification tool to evaluate clinical proton treatment plans,in order to reduce the beam time for dose verification and thus increase the number of patient treatment in proton therapy.

Objective: To investigate the effect of lipiodol as embolization agents in liver, after transcatheter arterial chemoembolization, on dose calculation under the carbon ion treatment plan. Methods: The actual relative linear stopping powers(RLSP)in pure lipiodol, pure gel and lipiodol-gel mixture, together with the correctd RLSPs from their CT images, were compared.In seven typical cases with lipiodol deposition area, carbon ion treatment plan was performed for the original lipiodol images.Successively on the basis of analysis that has made, the RLSP in lipiodol deposition area was corrected to be as in normal liver tissue, for which the carbon ion treatment plan was again performed.A comparison was made of differences in water equivalent depth (WED) and dose distribution on different CT images. Results: The RLSP value corrected according to CT image HU value, lipiodol, and lipiodol-gel mixture may increase by 4.6%-139.0% compared with the measured value. In seven typical cases, deposited lipiodol can cause WED to increase by (0.89±0.41) cm along the field track and RBE by(3.83±1.71)Gy within the 1 cm of distal area of target. Conclusions In order to improve the accuracy of dose distribution calculation, the HU value and/or RLSP in deposited lipiodol area in liver after transcatheter arterial chemoembolization should being corrected to be as in the normal liver tissue.

Objective: Systematic assessment of the effect of positive margin on recurrence and metastasis in patients with renal cell carcinoma who underwent partial nephrectomy. Methods: The literature were searched on the rate of recurrence and metastasis in patients with positive margin and partial nephrectomy published in PubMed, Embase, Cochrane, China Biomedical Literature Database, China Knowledge Network, VIP Chinese Science and Technology Journal Database, and Wanfang Chinese Database up to December 2018. The quality of the literature included in this study was evaluated by two reviewers, and a meta-analysis was performed on the literature that met the inclusion criteria using the Revman 5.0 statistical software provided by Cochrane Collaboration. Results: A total of seven articles were included, six of which were case-control studies, and the other one was a cohort study. These seven articles consisted of 6 928 patients, including 407 positive margins and 6 521 negative margins. For recurrence and metastasis, 407 positive margins were composed of 25 recurrences and 21 distant metastases, while 6 521 negative margins consisted of 68 recurrence and 96 distant metastasis. The disease-free survival rate of patients with positive margins is lower than that with negative margins (OR=4.92, 95%CI 2.66-9.08, P<0.001). The results of subgroup analysis of patients with recurrence and metastasis based on positive margin exhibited that positive margin increased the risk of recurrence in patients undergoing partial nephrectomy (OR=5.05, 95%CI 2.06-12.37, P<0.001), as well as the risk of metastasis (OR=3.70, 95%CI 2.18-6.26, P<0.001). Since different studies consisted of patients with different tumor staging, a stratified analysis was conducted and the disease-free survival rate of patients with positive margins decreased compared with that of negative margins (OR=4.13, 95%CI 2.54-6.70, P<0.001), although there were differences in the staging of tumor patients included in different studies, which did not weaken the results. Conclusions Positive margins increase the risk of recurrence and metastasis in patients undergoing partial nephrectomy.

Objective To investigate EBT3 and EDR2 film responses to different linear energy transfers ( LETs) and doses from carbon ion beams. Methods EBT3 and EDR2 films were calibrated by two methods. In the first method, films were placed at the same depth within a phantom and irradiated by beams with different parameters such as beam energy. In the second method, films were separately placed at different depths in a phantom and irradiated by the same beams. These methods were used to irradiate films with ions of different LETs. Results For EBT3 film, the dose calibration curves correlated with different LETs appeared to be typical hyperbolic curves with a maximum difference between the curves of ± 17％ (1σ). Meanwhile, the shape of the dose calibration curves for EDR2 film appeared to be linear. The values along all these curves were within ± 27.4％ (1σ) of the value for the average curve. The dose responses of both films were inversely proportional to LETs. The sensitivity of EBT3 film was inversely proportional to the dose, while the sensitivity of EDR2 film showed no relationship with the dose. Conclusions Influenced by the dual factor of LET and dose, the application of EBT3 film was limited in carbon ion. However, without no dose dependence, EDR2 film could be used to measure dose distributions created by single LET carbon ion beam.