Objective To study the shielding effect of the protective door of a maze-free debugging room for an 18 MV medical linear accelerator and its influencing factors, and to provide guidance for protection of debugging personal against radioactive occupational disease hazards. Methods The investigation focused on the protective door of a newly constructed maze-free debugging room for an 18 MV medical linear accelerator. The protective door was made of the following shielding materials from inside to outside: 2.5 cm steel plate + 20 cm lead + 41 cm polyethylene containing 5% boron + 6 cm lead + 2.5 cm steel plate. The right side of the protective door was provided with a groove (commonly known as “door pocket”) lap. With different lap widths, irradiation directions, and installation positions of the accelerator base, FLUKE451P and WENDI II neutron detectors were used to measure the ambient dose equivalent rate of the points of interest outside the protective door. The shielding effect and influencing factors were analyzed. Results When the lap width at both sides of the protective door was 300 mm, the ambient dose equivalent rates outside the protective door were (1.37 ± 0.05) μSv/h on the side with “door pocket” and (4.71 ± 0.11) and (4.19 ± 0.11) μSv/h on the side without “door pocket”. When the primary beam of the accelerator was directed towards the east, the ambient dose equivalent rates at the points of interest outside the protective door were higher than those of the corresponding points of interest when the primary beam was directed towards other directions. When the accelerator base was located on the south side of the machine room, the ambient dose equivalent rates of the points of interest outside the protective door under the same irradiation conditions were lower than those when the accelerator base was located on the north side of the machine room. Conclusion The study of an 18 MV accelerator and its maze-free debugging room showed that the radiation of photons and neutrons should be taken into consideration when designing the protective door at the entrance. The protective door with shiplaps on both sides of the wall has improved shielding effect outside the door.

Renal colic caused by ureteral stone obstruction is the main cause for emergency treatment of patients with urinary tract stones, and drug expulsion therapy plays a vital role in the treatment.This article delves into a variety of drugs, including α1 adrenergic receptor blockers, β adrenergic receptor agonists, calcium channel blockers, prostaglandin synthetase inhibitors, corticosteroids, phosphodiesterase isoenzyme 5 inhibitors, and Chinese herbal medicines, exploring their mechanisms and applications in the treatment of distal ureteral stones.Currently, α1 adrenergic receptor blockers are still preferred for the treatment of distal ureteral stones due to their significant efficacy.It is worth noting that various drugs work through different mechanisms, and combining drugs with different mechanisms is expected to improve the efficiency of stone expulsion.This method may become the mainstream choice for stone expulsion drugs in the future.This article aims to provide new perspectives and ideas for the drug treatment of urinary tract stones.

Objective:To investigate the immunophenotypic and molecular biological characteristics of patients with elevated serum alpha-fetoprotein (AFP) and enteroblastic differentiated gastric adenocarcinoma (GAED).Methods:The clinicopathological data of 13 patients with elevated serum AFP and GAED admitted to Shanxi Cancer Hospital from 2018 to 2020 were collected. Immunohistochemistry (IHC) and next-generation sequencing (NGS) were used to analyze the immune markers and molecular biological characteristics of the pathological tissues of the patients. Kaplan-Meier method and log rank test were used for survival analysis.Results:Among the 13 patients with GAED, 12 were male and 1 was female, aged 41-70 years, with a median age of 64 years. The lesions were mainly located in the gastric antrum (5 cases) and gastric body (4 cases). IHC results showed that the tumor embryonic protein (AFP, SALL4, GPC3), intestinal epithelial differentiation protein (CDX-2, CD10), and some original intestinal epithelial phenotype markers (OCT3/4, Claudin6) were expressed in the tumor tissues. Combined application of multiple markers can reduce the rate of missed diagnosis. Among the 13 patients, 12 had at least one mutation (1 mutation: 1 case, 2-5 mutations: 3 cases, 6-15 mutations: 8 cases), and 1 case was not detected. The gene with the highest mutation frequency was TP53 (10 cases), and other mutant genes included EPHB1 (3 cases), ATRX (2 cases), EPHA5 (2 cases), GATA3 (2 cases), LRP1B (2 cases) and MAP2K4 (2 cases) were also detected. Three of the 13 patients had structural variations, which were C14orf177- GNAS, AIM1- FGFR3, and EPHA6- ROS1 gene rearrangements. All 13 patients had copy number variation, and 11 patients had copy number variation of more than 2 genes. The common amplification genes were IRS2 (5 cases), PTEN (5 cases), GNAS (4 cases), CCNE1 (3 cases), CEBPA (3 cases), PCK1 (3 cases) and ERBB2 (2 cases). The common deletion genes were SOX2 (5 cases) and MYC (5 cases). Among the 13 patients, 4 died, and 2 of the dead patients had liver metastasis. There were 4 patients with disease-free survival and 5 patients with disease progression, including 3 cases of abdominal metastasis and 2 cases of liver metastasis. The 3-year survival rate of patients was 65.9 %, and the 3-year progression-free survival rate was 30.7 %. Gene LRP1B point mutation was associated with poor prognosis ( P＜0.001). There was no significant improvement in the prognosis of patients treated with immunotherapy compared with those treated with chemotherapy alone ( P=0.595), but the prognosis of patients treated with postoperative chemotherapy or postoperative chemotherapy plus immunotherapy was better than that of patients treated with surgery alone ( P＜0.05). Conclusions:Elevated serum AFP with GAED is a highly invasive tumor with unique molecular characteristics, often accompanied by multiple molecular events. TP53 mutation is the most common type of gene mutation. In addition, some cases are accompanied by HER2 amplification and gene rearrangement.

Objective:To investigate the immunophenotypic and molecular biological characteristics of patients with elevated serum alpha-fetoprotein (AFP) and enteroblastic differentiated gastric adenocarcinoma (GAED).Methods:The clinicopathological data of 13 patients with elevated serum AFP and GAED admitted to Shanxi Cancer Hospital from 2018 to 2020 were collected. Immunohistochemistry (IHC) and next-generation sequencing (NGS) were used to analyze the immune markers and molecular biological characteristics of the pathological tissues of the patients. Kaplan-Meier method and log rank test were used for survival analysis.Results:Among the 13 patients with GAED, 12 were male and 1 was female, aged 41-70 years, with a median age of 64 years. The lesions were mainly located in the gastric antrum (5 cases) and gastric body (4 cases). IHC results showed that the tumor embryonic protein (AFP, SALL4, GPC3), intestinal epithelial differentiation protein (CDX-2, CD10), and some original intestinal epithelial phenotype markers (OCT3/4, Claudin6) were expressed in the tumor tissues. Combined application of multiple markers can reduce the rate of missed diagnosis. Among the 13 patients, 12 had at least one mutation (1 mutation: 1 case, 2-5 mutations: 3 cases, 6-15 mutations: 8 cases), and 1 case was not detected. The gene with the highest mutation frequency was TP53 (10 cases), and other mutant genes included EPHB1 (3 cases), ATRX (2 cases), EPHA5 (2 cases), GATA3 (2 cases), LRP1B (2 cases) and MAP2K4 (2 cases) were also detected. Three of the 13 patients had structural variations, which were C14orf177- GNAS, AIM1- FGFR3, and EPHA6- ROS1 gene rearrangements. All 13 patients had copy number variation, and 11 patients had copy number variation of more than 2 genes. The common amplification genes were IRS2 (5 cases), PTEN (5 cases), GNAS (4 cases), CCNE1 (3 cases), CEBPA (3 cases), PCK1 (3 cases) and ERBB2 (2 cases). The common deletion genes were SOX2 (5 cases) and MYC (5 cases). Among the 13 patients, 4 died, and 2 of the dead patients had liver metastasis. There were 4 patients with disease-free survival and 5 patients with disease progression, including 3 cases of abdominal metastasis and 2 cases of liver metastasis. The 3-year survival rate of patients was 65.9 %, and the 3-year progression-free survival rate was 30.7 %. Gene LRP1B point mutation was associated with poor prognosis ( P＜0.001). There was no significant improvement in the prognosis of patients treated with immunotherapy compared with those treated with chemotherapy alone ( P=0.595), but the prognosis of patients treated with postoperative chemotherapy or postoperative chemotherapy plus immunotherapy was better than that of patients treated with surgery alone ( P＜0.05). Conclusions:Elevated serum AFP with GAED is a highly invasive tumor with unique molecular characteristics, often accompanied by multiple molecular events. TP53 mutation is the most common type of gene mutation. In addition, some cases are accompanied by HER2 amplification and gene rearrangement.

Objective:To construct a nomogram model predicting the occurrence of acute kidney injury (AKI) in patients with sepsis in the intensive care unit (ICU), and to verify its validity for early prediction.Methods:Sepsis patients admitted to the ICU of the Affiliated Hospital of Jining Medical University from April 2015 to December 2021 were retrospectively included, and those who met the inclusion criteria were randomly divided into training and validation sets at a ratio of 7:3. Univariate and multivariate logistic regression models were used to identify independent risk factors for AKI in patients with sepsis, and a nomogram was constructed based on the independent risk factors. Calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used to evaluate the nomogram model.Results:741 patients with sepsis were included in the study, 335 patients developed AKI within 7 d of ICU admission, with an AKI incidence of 45.1%. Randomization was performed in the training set ( n=519) and internal validation set ( n=222). Multivariate logistic analysis revealed that acute physiology and chronic health status score Ⅱ, sequential organ failure score, serum lactate, calcitoninogen, norepinephrine dose, urea nitrogen, and neutrophil percentage were independent factors influencing the occurrence of AKI, and a nomogram model was constructed by combining these variables. In the training set, the AUC of the nomogram model ROC was 0.875 (95% CI: 0.767-0.835), the calibration curve showed consistency between the predicted and actual probabilities, and the DCA showed a good net clinical benefit. In the internal validation set, the nomogram model had a similar predictive value for AKI (AUC=0.871, 95% CI: 0.734-0.854). Conclusions:A nomogram model constructed based on the critical care score at admission combined with inflammatory markers can be used for the early prediction of AKI in sepsis patients in the ICU. The model is helpful for clinicians early identify AKI in sepsis patients.

The fall armyworm (FAW), Spodoptera frugiperda, is a destructive pest native to America and has recently become an invasive insect pest in China. Because of its rapid spread and great risks in China, understanding of FAW genetic background and pesticide resistance is urgent and essential to develop effective management strategies. Here, we assembled a chromosome-level genome of a male FAW (SFynMstLFR) and compared re-sequencing results of the populations from America, Africa, and China. Strain identification of 163 individuals collected from America, Africa and China showed that both C and R strains were found in the American populations, while only C strain was found in the Chinese and African populations. Moreover, population genomics analysis showed that populations from Africa and China have close relationship with significantly genetic differentiation from American populations. Taken together, FAWs invaded into China were most likely originated from Africa. Comparative genomics analysis displayed that the cytochrome p450 gene family is extremely expanded to 425 members in FAW, of which 283 genes are specific to FAW. Treatments of Chinese populations with twenty-three pesticides showed the variant patterns of transcriptome profiles, and several detoxification genes such as AOX, UGT and GST specially responded to the pesticides. These findings will be useful in developing effective strategies for management of FAW in China and other invaded areas.
Animals ; China ; Genomics ; Humans ; Male ; Pesticides ; Spodoptera/genetics* ; Transcriptome

Objective:To explore the efficacy, adverse reactions, and feasibility of high-definition transcranial direct current stimulation(HD-tDCS) treating major depressive disorder(MDD) patients with anxious distress.Methods:Sixty cases of MDD with anxious distress admitted to Zhenjiang Mental Health Center were recruited as participants. All patients were allocated into either the active treatment group or the sham group based on the random number table method. HD-tDCS was utilized in both groups to stimulate the left dorsolateral prefrontal cortex on the basis of conventional antidepressant treatment. In the active group, 2mA current stimulation was used for 20 min, and in the sham group, a 30-sceond stimulation was adopted at the beginning and the end of the stimulation. Participants in both group were treated once a day, five times a week for two consecutive weeks. Anxiety and depression symptoms of the patients were assessed respectively by the Hamilton depression scale(HAMD 17), the Montgomery-Asberg Depression Rating Scale(MARDS), the Hamilton Anxiety Scale(HAMA), and the Beck Anxiety Inventory(BAI) at the baseline, 2nd, 4th, and the 6th weekend of the treatment. The differences between active treatment and sham groups were analyzed by repetitive measure analysis of variance and simple effect analysis. Fisher′s exact probability test was used to compare the effective rate, remission rate and adverse reaction rate between the two groups. Results:(1) The interaction of times and groups was significant in HAMD 17( F=3.29, P<0.05) and BAI( F=2.99, P<0.05). In all measurement instruments, the main effects of groups( F=4.40-7.94) and times( F=35.42-247.59) were significant( P<0.05).(2) Findings from the simple effect analysis showed that: there were no significant differences in the scores of HAMD 17 at baseline and the 2 nd assessment between the two groups. Similarly, no significant differences were found in BAI at baseline, the 2nd and the 6th weekend of the treatment between two groups( P>0.05).(3) The scores of HAMD 17 at the 4th and the 6th week, BAI at the 4th weekend of the treatment in the active group were significantly lower than that in the sham group( P<0.05).(4) At the 4th weekend of the treatment, the active group had a remission rate of 16/20 and a response rates of 19/20, which were higher than 9/19 and 13/19, respectively, in the sham group( P<0.05). Also, the remission rate(18/20) in the active group was higher than that in the sham group(11/19) at the 6th weekend of the treatment.( P<0.05). As for the response rates, differences were not found between the two groups at the 6th weekend of the treatment.(5) The overall dropout rate had no significant differences in-between( P>0.05). As for the safety outcome, the rate of adverse events(e.g., itching, tingling and headache) showed no significant differences between the two groups. Additionally, no severe adverse events or mania was reported. Conclusions:This study indicated that HD-tDCS has significant efficacy and high safety in the treatment among MDD patient with anxious distress. Nevertheless, further large sample clinical studies are warranted to confirm the findings of the current investigation.

Objective:To explore the efficacy, adverse reactions, and feasibility of high-definition transcranial direct current stimulation(HD-tDCS) treating major depressive disorder(MDD) patients with anxious distress.Methods:Sixty cases of MDD with anxious distress admitted to Zhenjiang Mental Health Center were recruited as participants. All patients were allocated into either the active treatment group or the sham group based on the random number table method. HD-tDCS was utilized in both groups to stimulate the left dorsolateral prefrontal cortex on the basis of conventional antidepressant treatment. In the active group, 2mA current stimulation was used for 20 min, and in the sham group, a 30-sceond stimulation was adopted at the beginning and the end of the stimulation. Participants in both group were treated once a day, five times a week for two consecutive weeks. Anxiety and depression symptoms of the patients were assessed respectively by the Hamilton depression scale(HAMD 17), the Montgomery-Asberg Depression Rating Scale(MARDS), the Hamilton Anxiety Scale(HAMA), and the Beck Anxiety Inventory(BAI) at the baseline, 2nd, 4th, and the 6th weekend of the treatment. The differences between active treatment and sham groups were analyzed by repetitive measure analysis of variance and simple effect analysis. Fisher′s exact probability test was used to compare the effective rate, remission rate and adverse reaction rate between the two groups. Results:(1) The interaction of times and groups was significant in HAMD 17( F=3.29, P<0.05) and BAI( F=2.99, P<0.05). In all measurement instruments, the main effects of groups( F=4.40-7.94) and times( F=35.42-247.59) were significant( P<0.05).(2) Findings from the simple effect analysis showed that: there were no significant differences in the scores of HAMD 17 at baseline and the 2 nd assessment between the two groups. Similarly, no significant differences were found in BAI at baseline, the 2nd and the 6th weekend of the treatment between two groups( P>0.05).(3) The scores of HAMD 17 at the 4th and the 6th week, BAI at the 4th weekend of the treatment in the active group were significantly lower than that in the sham group( P<0.05).(4) At the 4th weekend of the treatment, the active group had a remission rate of 16/20 and a response rates of 19/20, which were higher than 9/19 and 13/19, respectively, in the sham group( P<0.05). Also, the remission rate(18/20) in the active group was higher than that in the sham group(11/19) at the 6th weekend of the treatment.( P<0.05). As for the response rates, differences were not found between the two groups at the 6th weekend of the treatment.(5) The overall dropout rate had no significant differences in-between( P>0.05). As for the safety outcome, the rate of adverse events(e.g., itching, tingling and headache) showed no significant differences between the two groups. Additionally, no severe adverse events or mania was reported. Conclusions:This study indicated that HD-tDCS has significant efficacy and high safety in the treatment among MDD patient with anxious distress. Nevertheless, further large sample clinical studies are warranted to confirm the findings of the current investigation.

Objective To evaluate the effect of preoperative sleep deprivation on hippocampal Tolllike receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB) signaling pathway in aged mice with postoperative cognitive dysfunction.Methods Sixty clean-grade healthy male C57BL/6J mice,aged 16 months,weighing 28-36 g,were divided into 4 groups (n=15 each) using a random number table method:control group (group C),surgery group (group S),sleep deprivation group (group SD) and sleep deprivation plus surgery group (group SD+S).Mice were fed a common diet in group C.Mice were sleep-deprived for 24 h in group SD.Tibial fracture internal fixation was performed in group S.Tibial fracture internal fixation was performed after 24-h sleep deprivation in group SD+S.Cognitive function was assessed using the contextual fear conditioning test at days 3 and 7 after operation.The animals were sacrificed at day 7 after operation,brains were removed and hippocampi were isolated for determination of tumor necrosis factor-alpha (TNF-α) content (by enzyme-linked immunosorbent assay) and expression of TLR4 and p-NF-κB p65 (by Western blot).Results Compared with group C,the percentage of time spent freezing induced by condition and percentage of time spent freezing induced by context were significantly decreased at days 3 and 7 after operation,the content of TNF-α was increased,and the expression of TLR4 and p-NF-κB p65 was up-regulated in S,SD and SD+S groups (P＜0.05).Compared with group S and group SD,the percentage of time spent freezing induced by condition and percentage of time spent freezing induced by context were significantly decreased at days 3 and 7 after operation,the content of TNF-α was increased,and the expression of TLR4 and p-NF-κB p65 was up-regulated in group SD+S (P＜0.05).Conclusion Preoperative sleep deprivation further accentuates postoperative cognitive dysfunction,and the mechanism is related to activating TLR4/NF-κB signaling pathway and inducing inflammatory responses of aged mice.