Objective:To study and design one kind of flash radiotherapy(Flash-RT)equipment with ultra-high dose rate,which can be used in the mechanism research of Flash-RT with ultra-high dose rate.Methods:Based on the technique roadmap of high-power petal accelerator,the Flash-RT equipment can realize the requirement of Flash-RT for ultra-high dose rate and multiple irradiation angles.The corresponding design and research work were carried out on the basis of the overall design of the equipment,the main components and characteristics,the dynamics design of beam,the construction of movable and preliminary experimental platform,etc.Result:The dose rate of the designed equipment can reach to 100 Gy/s at a distance of 0.8 meters from the target point,which is easy to realize the radiotherapy method with multi angles.Conclusion:The designed X-ray equipment based on the technique roadmap of high-power petal accelerator can realize the research for the mechanism of medical Flash-RT equipment with ultra-high dose rate.

The protection effect of flash-radiotherapy(Flash-RT)with super-high dose on normal tissue has obtained wide attention in therapeutic radiology since it was found in 2014 year.The increasing research demand of Flash-RT with super-high dose-rate proposed new challenge for the existing radiotherapy equipment.Based on the demands of FLASH-RT research and clinical application,this review analyzed the proposed new requirement of Flash-RT for equipment,and introduce current scientific facilities with the experimental ability of X-ray FLASH-RT,as well as the situation of the specialized FLASH-RT equipment which were developing.The research of Flash-RT mechanism need the existing equipment with high-energy X-ray source develop toward high power,while the clinical application of Flash-RT demand these transient high-power devices should possess a series of radiotherapy techniques such as multi angle irradiation,conformal radiotherapy and others.Currently,China's X-ray FLASH-RT research is at the forefront of the world,which is expected to achieve the first breakthrough of high-end medical equipment in the X-ray Flash RT field.

We retrospectively analyzed therapy efficacy and the adverse reactions of 10 patients suffering from systemic lupus erythematosus (SLE) with intestinal involvement treated with rituximab (RTX). Patients were hospitalized in the Department of Rheumatology and Immunology of the First Medical Center of PLA General Hospital from January 2015 to January 2023. Among the 10 patients, two were men and eight were women. The age of the cohort was (41.9±8.8) years. The age at disease onset was (28.8±9.2) years. The total course of the SLE diagnosis was(109.6±59.9) months. The course of the diagnosis of SLE with intestinal involvement was (89.3±50.2) months. The time from the appearance of intestinal symptoms to the diagnosis of SLE with intestinal involvement was 1.5 (1.0,8.0) months. The time from the diagnosis of SLE with intestinal involvement to RTX use was 13.0 (1.0,46.3) months. Follow-up duration after application of RTX treatment was (55.3±28.4) months. There were five cases of abdominal pain, four cases of abdominal distension, nine cases of diarrhea, three cases of nervous-system involvement, nine cases of lupus nephritis, and seven cases of serositis. All 10 patients underwent computed tomography and radiology of the abdomen. Eight patients had intestinal-wall edema, seven suffered intestinal dilation, four had target signs, three suffered congestion of mesenteric blood vessels, eight had increased mesenteric-fat density, and six had false intestinal obstruction. All 10 patients showed a low level of complement C3 (250-750 mg/L). Nine cases showed a low level of complement C4 (10-90 mg/L). The SLE disease activity index 2000 (SLEDAI-2K) at baseline in 10 patients was 20.5 (17.8, 30.0). After receiving RTX (0.5 g: day 1, day 14, or 375 mg/m 2: day 1, day 14) induction treatment, the intestinal symptoms of 10 cases were relieved completely. Four patients had adverse reactions, of which three received a high-dose glucocorticoid combined with RTX treatment simultaneously. Adverse reactions manifested mainly as a reduced level of IgG and infection with herpes simplex virus in one case, reduced level of IgG and lung infection in one patient, lung infection in one case, and reduced IgG level in one patient. RTX may an efficacious treatment strategy for patients suffering from refractory SLE with intestinal involvement.

OBJECTIVE AMPK activator,act as exer-cise mimetics,effective in preventing or ameliorating met-abolic diseases,including obesity and diabetes.Systemic activating of AMPK represents an important therapeutic strategy to treat metabolic diseases.However,whether far-infrared(FIR)hyperthermia therapy could be used as exercise mimetic to realize wide-ranging metabolic regu-lation,and its underling mechanisms remain unclear.METHODS The mice were subjected to hyperthermia in the FIR chamber(30±1)℃for 14 d.Exercise endurance was determined using a treadmill.Blood flow were mea-sured by the laser speckle contrast imaging.Combina-tion of microbiomic and metabolomic analysis,diversity of microbiota and metabolic profiling in muscle were detected.The microbiota disorder model via treatment with different cocktails of antibiotics(ABX).RESULTS The material characterization shows that the graphene synthesized by chemical vapour deposition(CVD)is dif-ferent from carbon fi ber,with single-layer structure and high electrothermal transform efficiency.The emission spectra generated by graphene-FIR device would maxi-mize matching those adsorbed by tissues(≈8.0 μm).Gra-phene-FIR improves core and epidermal temperature,and increases blood flow in femoral muscle and abdo-men.The diversity of gut microbiota was increased by graphene-FIR exposure.Graphene-FIR reduced the bac-teroidetes/firmicutes(B/F)ratio and increased the abun-dance of short-chain fatty acids(SCFA)-producing bac-teria,including Allobaculum,Blautia and Anaerostipes.Additionally,graphene-FIR stimulated the expression of SCFAs-sensing receptor(GPR 43),p-AMPK Thr172 and GLUT4,and increased the AMP/ATP ratio,thus enhanc-ing muscle glucose uptake.Metabolomic analyses revealed the significant changes in 25 metabolites,with twenty increased(eg.creatinine and phosphate)and five decreased(eg.lactic acid),and the marked impact of five metabolic pathways,including galactose metabo-lism,glycolysis,gluconeogenesis,fatty acid biosynthesis,butanoate metabolism,pyruvate metabolism.Further-more,a microbiota disorder model also demonstrates that the graphene-FIR effectively restore the exercise endurance with enhanced p-AMPK and GLUT4.CON-CLUSION Our results provide convincing evidence that graphene-based FIR therapy promoted exercise capacity and glucose metabolism via AMPK in gut-muscle axis.These novel insights into graphene-FIR therapy suggest a potential as an exercise mimetic for the treatment of metabolic disease in clinical.

The study aimed to analyze the efficacy and safety of rituximab in the treatment of 23 cases of lupus nephritis and explore the prospect of half-dose rituximab in lupus nephritis treatment. Twenty-three patients with lupus nephritis hospitalized in the Department of Rheumatology and Immunology at the First Medical Center of the PLA General Hospital from May 2013 to December 2021 were selected. Eighteen patients received rituximab 375 mg/m 2 on the first and 14th days, 5 patients received 500 mg of rituximab on the first and 14th days, and rituximab was used as needed 6 months later. Methylprednisolone (80-120 mg) was given together with rituximab. Afterward, 1 mg/kg prednisone was used for 4 weeks, which was progressively tapered to maintenance doses or discontinued. B lymphocyte level, renal function, 24-h urine protein level, and systemic lupus erythematosus (SLE) disease activity index 2000 (SLEDAI2K) score before and after treatment were recorded. The efficacy and adverse reactions were analyzed. The results showed that 11 patients suffered from renal insufficiency [creatinine (162.7±58.6) μmol/L ] at baseline, while the creatinine level of 9 patients returned to normal 12 months after the treatment [ (66.3±10.1)μmol/L ]. Normal renal function of the other 12 patients was maintained during treatment. After 12 months, the 24-h urine protein level decreased from 4.00 (2.00,6.80) g in the baseline period to 0.10 (0.08,0.40) g. SLEDAI2K score decreased from 22 (18,26) in the baseline period to 3 (0,6) 12 months after the treatment. The B lymphocyte level reached 0.00 (0.00,0.01)% at 3 months. Of 23 patients, 13 patients achieved complete remission, and 7 patients achieved partial remission after 6 months of rituximab treatment. Five patients experienced adverse reactions related to rituximab, including 1 case of transfusion reaction, 1 case of perioral herpes with pulmonary infection, and 3 cases of decreased IgG levels. Therefore, rituximab regimen used in this study can be an effective treatment strategy for lupus nephritis.

Objective:To compare the efficacy between dual stability constructs and modified Scott techniques for treatment of symptomatic spondylolysis in active adolescents.Methods:A retrospective study was conducted to analyze the clinical date of 64 active adolescents who had been treated for symptomatic spondylolysis at Department of Orthopedic Surgery, The 900th Hospital of Joint Logistic Support Force from January 2017 to October 2021. There were 59 males and 5 females with an age of (24.9±5.2) years. Responsible vertebral bodies were L 3 in 2 cases, L 4 in 10 cases, L 5 in 47 cases, and L 4 to L 5 in 5 cases; spondylolisthesis was accompanied in 9 cases. Depending on the surgical methods, the patients were divided into a dual stability constructs (pedicle screws and laminar screws) group (observation group, 31 cases) and a modified Scott group (control group, 33 cases). The 2 groups were compared in terms of operative time, bleeding volume, postoperative drainage volume, isthmus healing rate, rate of internal fixation failure, visual analogue scale (VAS) for low back pain, Japanese Orthopaedic Association (JOA) score and the good and excellent rate by JOA at postoperative 1 month, 3 months, and the last follow-up, and the incidence of complications. Results:There was no statistically significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up. The operation time in the observation group [(94.7±14.9) min] was significantly longer than that in the control group [(84.4±16.4) min] ( P=0.011), but there was no significant difference in intraoperative bleeding volume or postoperative drainage volume ( P>0.05). The healing rate of bilateral isthmi in the observation group was 93.5% (29/31), significantly higher than that in the control group [60.6% (20/33)], and the rate of internal fixation failure in the observation group (0) was significantly lower than that in the control group (12.1%, 4/33) ( P<0.05). At postoperative 1 month, 3 months, and the last follow-up, the VAS scores were significantly lower than the preoperative value in all patients while the JOA scores significantly higher ( P<0.05). At the last follow-up, in the observation group the VAS score [0 (0, 1.0)] was significantly lower than that in the control group [1(0, 2)], and the JOA score [(27.1±1.2) points] and the excellent and good rate by JOA [93.5% (29/31)] were significantly higher than those in the control group [(25.7±2.1) points and 75.8% (25/33)] ( P<0.05). In the control group, follow-ups revealed internal fixation failure in 4 cases due to the cable cutting out of the spinous processes, yielding a failure rate of 12.1%, while no internal fixation failure was observed in the observation group. Conclusions:Both dual stability constructs and modified Scott techniques can relieve the clinical symptoms of spondylolysis in active adolescents to various extents. However, dual stability constructs with pedicle screws and laminar screws may lead to a higher isthmus healing rate and better curative effects.

Alphapapillomavirus ; Humans ; Lupus Erythematosus, Systemic ; Papillomavirus Infections/prevention & control* ; Vaccination

ObjectiveTo understand the cooperative work and mechanism in the corona virus disease 2019 containment action by the support-to-Hebei epidemiological investigation group formed by five provinces， summarize the existing challenges， and discuss the relevant mechanism， so as to provide evidence for future support actions. MethodsA questionnaire survey was used to investigate the members from five provinces of the support-to-Hebei epidemiological investigation team. The content included basic information， work situation， problems in cooperative work， and suggestions in support mechanisms. ResultsA total of 104 questionnaires were issued， of which 101 valid questionnaires were collected with an effective response rate of 97.12%. The proportions of respondents who participated in the epidemic-related data preparation， case investigation， technical training， supervision of key venues， and specimen collection was 93.07%， 85.15%， 81.19%， 65.35%， and 44.55%， respectively. The respondents believed that information sharing channel of local epidemic situation was blocked （95.05%）， coordination mechanism among local departments was insufficient （84.16%）， communication and coordination mechanism among the dispatch institutions， support team， and local departments was unperfect （84.16%）， management of the dispatch institutions to the support team was relatively loose （79.21%）， dispatch institutions failed to make full use of professional advantages of the support team （72.28%）， and majority of the support team members engaged in a single profession （59.41%）. The respondents suggested that local departments should improve the information sharing mechanism （95.05%）， strengthen communication and coordination among the dispatch institutions， support team， and local departments （92.08%）， and dispatch institutions should clarify the tasks and responsibilities of the support team （91.09%）， formulate cross-regional emergency support plans （87.13%） and evaluation plans of support action （72.28%）. ConclusionIn order to ensure the efficiency and accuracy of future support actions， it is necessary to improve the mechanism of emergency coordination， communication and matching， response procedures， team management， and support evaluation.

A 28-year-old man was admitted to the first medical center of Chinese People′s Liberation Army General Hospital because of multiple myalgia and intramuscular nodules for more than 2 months. The patient complained of dysphagia, fever and weight loss 2 months ago. Magnetic resonance imaging and biopsy revealed nodular fasciitis. Inflammatory indicators including C-reactive protein, erythrocyte sedimentation rate, platelet count and fibrinogen were slightly elevated. Urine occult blood was positive. Abdominal ultrasound revealed left hydronephrosis. Because nodular fasciitis could not explain the whole situation, a needle biopsy of intramuscular nodules was performed. Pathological examination revealed intramuscular metastatic adenocarcinoma with poor differentiation. Gastric endoscope and positron emission tomography-computed tomography confirmed the diagnosis of advanced gastric adenocarcinoma with extensive metastases of esophagus, lymph nodes, muscles, ureter and bone. Although chemotherapy was given, the patient died of disease progression six months later.

Objective To investigate the efficacy of arthroscopic synovectomy on refractory knee arthritis complicated with popliteal cyst.Methods Patients diagnosed as rheumatoid arthritis (RA) or spondyloarthritis (SPA) with refractory knee arthritis who underwent knee arthroscopic synovectomy in our hospital from 2010 to 2017 were enrolled,including 20 patients (16 RA,4 SpA) with popliteal cyst.Clinical data,RA disease activity score (DAS28),SpA back pain score,etc,were collected to evaluate the efficacy of knee surgery.Results Erythrocyte sedimentation rate (ESR) [58(17,79)mm / 1h vs.19(9,30)mm/1h,P＜ 0.001],C reactive protein (CRP) [3.72(0.92,8.14) mg/L vs.0.85(0.10,3.08) mg/L,P＜0.001],rheumatoid factor [64.6(20.2,193.3) vs.20.5(10.0,58.4),P＜0.001],DAS28 score(4.67±1.25 vs.2.81±1.23,P＜0.001),knee joint discomfort score [5(4,6) vs.2(1,3),P＜0.001] and the volume of knee joint effusion by ultrasound (P＜0.05) in 95 RA patients were significantly decreased compared to those before operation.ESR [27(12,54)mm/1h vs.20 (16,28) mm/1 h,P＜0.001],CRP [3.27(1.06,6.95) mg/L vs.1.41(0.34,3.03)mg/L,P＜0.001],knee discomfort score [2(0,5) vs.1(0,3),P＜0.05],back pain visual analogue score (VAS) [5(4,5) vs.2(1,3),P＜0.001],and the volume of knee joint effusion by ultrasound (P＜0.001) in 58 SpA patients were significantly lower than those before the operation.The rate [16.84％(16/95) vs.6.32％(6/95),P=0.023] and grading (P=0.007) of popliteal cyst in RA were decreased after the operation.No statistically difference was observed in the rate [6.90％ (4/58) vs.5.17％(3/58),P=0.697] of popliteal cyst in patients with SpA,yet with a trend of decrease in 4 patients.Conclusion This study provide evidence that knee arthroscopic synovectomy has a good effect for refractory knee arthritis,which can reduce disease activity,improve joint symptoms and decrease the grading of popliteal cyst.