Type 1 diabetes mellitus(T1DM)is an autoimmune diabetes caused by the destruction of βcells and insulin absolute insufficiency,which is influenced by a combination of genetic and environmental fac-tors.In recent years,gut microbiota as an important part of regulating host disease and health status has re-ceived the extensive attention.Small intestinal bacterial overgrowth(SIBO)is a type of intestinal microbial dysbiosis that is associated with T1DM.The presence of SIBO may exacerbate the development of T1DM,which is closely associated with the high incidence of SIBO,however,the causal relationship between SIBO and T1DM and its specific mechanism of action are not well elucidated.This article reviews the relationship and interaction between SIBO and T1DM,and its potential mechanisms and interventional measures,which may help to discover the new therapeutic targets and develop the new treatment regimens for T1DM.

Objective To observe the clinical characteristics of rhegmatogenous retinal detachment (RRD) secondary to conservative therapy in retinoblastoma (RB) patients.Methods A retrospective study. From July 2013 to May 2017, 20 RRD patients (20 eyes) of 456 RB patients (573 eyes) treated in Xinhua Hospital of Shanghai Jiao Tong University School of Medicine were included in the study. Eleven patients (11 eyes) were boy and 9 patients (9 eyes) were girls. Thirteen patients demonstrated bilateral RB and 7 patients had unilateral RB. Average age when diagnosed with RB was 25 months. International Classification of Retinoblastoma groups were C in 1 eye, D in 17 eyes, and E in 2 eyes. These patients received intra-arterial chemotherapy (17 eyes), intravenous chemotherapy (11 eyes), intravitreal chemotherapy (8 eyes), laser (14 eyes) and/or cryotherapy (5 eyes). Twelve patients (12 eyes) received vitreoretinal surgery including vitrectomy (6 eyes) and scleral buckling (7 eyes). The mean follow-up was 39 months. Fundus examination was performed under general anesthesia during comprehensive treatment and follow-up. The time interval of fundus examination varied from 1 to 6 months depending on the stability of the tumor.Results RRD was noted in 20 eyes (3.5％) with RB. Retinal hole was found in 15 eyes (75％). The cause of RRD was atrophic hole in calcified tumor (6 eyes, 30％), cryotherapy-related hole (5 eyes, 25％) and laser-related hole (9 eyes, 45％). Multiple atrophic hole in calcified tumor was noted in 3 eyes. Size of hole smaller than 2 DD was noted in 8 eyes (53％), and larger than 2 DD was noted in 7 eyes (47％). Holes were in posterior (3 eyes), equator (2 eyes) and periphery (10 eyes). Severe proliferated was noted in 1 eye. No tear was found. No bulbar retinal detachment and choroidal detachment was noted. Among 12 eyes who underwent vitreoretinal surgery, reattachment was achieved in 9 eyes (75％). No metastasis was noted.Conclusions Calcified regression of tumor, cryotherapy and laser were main reasons of RRD. Most of the holes are small in diameter and located in the periphery.

Objective To investigate the acute adverse reactions of craniospinal irradiation with helical tomotherapy in medulloblastoma patients and its risk factors. Methods A total of 20 patients with medulloblastoma who received craniospinal irradiation with helical tomotherapy between October 2012 and September 2016 in Air Force General Hospital were selected. The acute adverse events of 20 patients during the treatment were record. According to National Cancer Institute Common Terminology Criteria Adverse Events (NCI-CTCAE) version 4.0, the adverse reactions were divided into the mild group (grade 0-Ⅱ) and severe group (grade Ⅲ-Ⅳ) adverse reactions. And the risk factors were also analyzed. Results The non-hematological adverse reactions included fatigue (55％), vomiting (45％) and headache (25％). The hematological adverse reactions included leukopenia (95％), thrombocytopenia (55％) and lower hemoglobin (45％), and the incidence of severe adverse reactions was 35％ (7/20), 20％ (4/20) and 0 ( 0/20 ) , respectively . Leukopenia occurred in 18 patients ( 90％) at the beginning of radiotherapy within 2 weeks, and thrombocytopenia occurred in 8 patients (40％) at the beginning of radiotherapy after 2 weeks. Single factor analysis showed that there were no statistical differences in hematological adverse events of gender, age and radiation dose of spinal cord (all P>0.05). The incidence of leukopenia for the patients who received the chemotherapy before the radiotherapy was higher than that for the patients without the chemotherapy before the radiotherapy (P< 0.05). Conclusions The hematological adverse reactions were the major acute adverse events during the craniospinal irradiation with helical tomotherapy in patients with medulloblastoma. Theincidence of leukopenia and thrombocytopenia is common, and the incidence of hematological adverse reactions is higher after the chemotherapy. Thus, the close monitoring of hemogram change and treatment of hematological adverse reactions in time during the radiotherapy should be taken into the consideration.

Objective To introduce the therapeutic procedures of helical tomotherapy based total marrow irradiation(HT-TMI), and validate the feasibility of TMI. Methods At 1 week before bone marrow transplantation,12 patients received TMI conditioning regimen at a prescriptive dose of 12 Gy in 3 times,once daily. Patient immobilization, CT simulation, target delineation, plan design and dosimetric verification were implemented in sequence according to the TMI procedures. The dosimetric paramaters of the target and normal tissues were analysed. The correlation between the dose verification and image-guided results was observed. Results Compared with total body irradiation(TBI), TMI could significantly reduce the irradiation dose to normal tissues. The median dose D50of all normal tissues except the oral cavity were lower than 6 Gy,where The D50of lens,brain,lung and liver are (1.8±0.1) Gy, (5.7±0.2) Gy, (5.2±0.2) Gy, and (4.6±0.2) Gy, respectively. Pass rate of γ Index was larger than 95% with 3mm/3% criterian for each section. The positioning error of head and neck was relatively lower than that of pelvis at x-axis,and was higher at z-axis.Conclusions Helical tomotherapy based TMI is a feasible and reasonable approach,which has evident dosimetric advantage.

Objective To prospectively determine the feasibility of high-resolution in vivo MR imaging in the evaluation of esophageal carcinoma invasion at 3.0 T.Methods One hundred and eighteen patients with esophageal carcinoma,proven by the gastroscopic biopsy,were prospectively studied using 3.0 T MR.The esophageal specimens were sectioned transversely to keep consistent in the orientation with the MR images,the histopathological stage was made and the thickness of the tumor on the largest diameter of the slice were measured.The MR images were reviewed in the transverse plane.According to the seventh American joint committee on cancer,the MR stage was made and the tumor's thickness was measured.The MR images and the histopathological slices were matched.The staging diagnostic efficacy of the MR imaging was evaluated with the histopathological results as the standard reference,Kappa test was used to compare the stage of MR imaging with that at the histopathological analysis.Bland-Altman scatterplots were used to compare the thickness of tumor measured on the MR images with that at the histopathological measurement.Results Ninety seven cases(82.2％,97/118) of MR stage were accurately made,including 7 T1a,15 T1b,18 T2,25 T3 and 32 T4a cases,furthermore,14 cases were over staged and 7 cased were underestimated.The MR stage was highly consistent with the histopathological stage (Kappa=0.772).The sensitivity for the staging of high-resolution MR imaging at 3.0 T was 58.3％(7/12) to 100.0％(32/32),the specificity was 95.3％ (82/86) to 98.1％ (104/106),and the accuracy was 91.5％ (108/118) to 96.6％ (114/118),respectively.Bland-Altman scatterplots demonstrated that the discrepancy of the mean thickness between the value obtained by three radiologists respectively and the histopathological analysis were 2.0,2.6 and 2.1 mm,which demonstrated a good consistency.Conclusion High-resolution MR images obtained at 3.0 T can be used to evaluate the depth of carcinoma invasion and provide excellent diagnostic accuracy for preoperative staging.

Objective To seek a optimization method for lung cancer planning with Helical TomoTherapy for reducing the low dose area of total lung.Methods CT images of thirty patients with unilateral lung cancer were selected.Seven plans (Groups A,B,C,D,E,F and G) were generated for each patient using an identical optimization procedure with the conditions that implemented contralateral lung with unblocked (control group),1/4 directional block,1/2 directional block,directional block,1/4 complete block,1/2 complete block and complete block,respectively.The benefits in different schemes of reducing the low dose area of normal lung tissue were estimated,in order to provide a reference treatment plan scheme in clinical.Results Groups B,C,D and E had less influence on the target than that of group A.And there were no statistical difference between the target dosimetric parameters.The median dose and average dose of group F were increased within 0.5 Gy.The conformal index of group G had great influence on the target.The low dose area of total lung were reduced effectively in Groups C,D,E,F and G,the average decrease of V5 and V10 was 8.06％-45.26％ and 6.21％-33.95％,respectively.The V20 decreased by 1.71％-3.78％ in directional block group,while V20 increased in complete block group (2.07％-5.07％).The single treatment time was increased by 8.51％-79.22％.Conclusions The results showed that the low dose area of total lung was higher for the plan without any block limitation.It could reduce the low dose area of total lung with directional block.We should lengthen the blocking arc of contralateral lung with directional block based on the fractional treatment time and the patient's physical condition.A certain arc of contralateral lung with complete block could effectively reduce low dose area.When complete block was used,it is suggested that the arc was no more than half of the contralateral lung.

Objective To study the dose characteristics of Body γ Knife and Tomotherapy treatment plans for hepatocellular carcinoma,and compare their differences between organs at risk (OAR) dose and the range of low dose.Methods CT simulation images of twelve patients with hepatocellular carcinoma were selected,the target volume and OAR were drew by doctor.Body γ Knife and Tomotherapy treatment plans were optimized with their own planning station.The dosimetric characteristics were evaluated by dose volume histograms and were compared.To analyze the difference between the two techniques,the paired t-test was applied.Results The Dmax and Dmean of target with Body γ Knife were higher than Tomotherapy (P =0.002,0.000),but the conformal index of PTV of Tomotherapy was superior to the Body γ Knife (P =0.001).The Dmax of spinal cord and left kidney with Body γ Knife was lower than Tomotherapy (P =0.013,0.012),and it was also in the Dean of stomach and left kidney (P =0.010,0.023).In the volume dose comparison,the V40,V35,V30,V25 and V20 of normal tissue (all Body-PTV) and liver (all liver-GTV) with Body γ Knife were higher than Tomotherapy (P =0.001,0.001,0.001,0.007,0.029),but the V10 and V5 were lower (P =0.019,0.031),the Dmax of stomach,Dmean of right kidney and liver were no statistical difference (P =0.247,0.308,0.401).Conclusions Both treatment plans could meet the clinical dosimetric need,by the same prescription dose,Dmax and Dmean of target of Body γ Knife were higher than Tomotherapy.Tomotherapy had excellent dose-target conformal and could reduce the range of V25-V40 of OAR and normal tissue,but the range of V5-V10 was increased obviously.

Objective To identify dosimetric predictors for the development of gastrointestinal toxicity in patients with pancreatic adenocarcinoma treated with TOMO radiotherapy .Methods From January 2014 to Janu-ary 2015 ,we analysed the medical records of 68 pancreatic cancer patients who received helical tomotherapy from Air Force General Hospital .The stomach and duodenum were contoured separately to determine their dose volume histogram(DVH)parameters.Chi-square test was employed to analyze the count data .Spearman correlation anal-ysis was used to analyze the relationship between occurrence of gastrointestinal toxicity and clinical and physical factors.Logistic regression models was performed to identify risk factors associated with gastrointestinal toxicity . Results The median follow-up was 9 months(4~16 months).18 patients experienced grade II acute gastroin-testinal toxicity ,1 patient experienced grade Ⅲ acute gastrointestinal toxicity , whereas 17 patients experienced grade II late gastrointestinal toxicity ,1 patient experienced grade Ⅲlate gastrointestinal toxicity .On UVA,the vol-ume,Dmean,D1,D3,D5,D10,V5 to V40,and V5′to V45′of duodenum were significantly associated with GradeⅡor higher gastrointestinal toxicity ( P <0.05 ) .The MVA, V45′of duodenum was independent predictor for gradeⅡor higher gastrointestinal toxicity(P<0.05).The ROC analysis also showed that V45′of 0.5cm3 was the optimal threshold to predict for gastrointestinal toxicity for the entire cohort .Conclusion V45′of duodenum is of greater importance in the judgment of occurrence of hypofractioned radiation -induced gastrointestinal toxici-ty.

Tomotherapy plans were produced using a combination of field widths (1 cm, 2.5 cm and 5 cm) and pitches (0.15, 0.30, and 0.45) for seven patients with brain metastases from lung cancer, the plans were compared with dosimetric parameters, protection of organs at risk (OAR) dose and treatment times. All plans were defined that CTV with 30Gy and GTV 50 Gy by ten fraction synchronously. The results showed that the mean dose and CI for GTV was statistical difference (P = 0.002 1, P = 0.012 8), OARs were within the normal range, the treatment time increased inversely proportional to the jaw width, but had lesser impact on the pitch. This study showed plans produced with 5 cm jaw was an effective method for patients with brain metastases from lung cancer.
Aged ; Brain Neoplasms ; diagnostic imaging ; secondary ; Female ; Humans ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Intensity-Modulated ; methods ; Tomography, Spiral Computed

Objective To analyze the setup errors of bone metastases patients by tomotherapy with megavoltage CT (MVCT) and calculate the CTV-PTV margins.Methods 30 patients with bone metastases were enrolled.All patients received tomotherapy,fixed with body net and received MVCT scanning before radiation.The MVCT images were registered with the kilovoltage CT (kVCT) images,the setup errors of X (lateral),Y (vertical),Z (longitudina) and Roll (transverse profile rotation) were obtained according to the formula M =2.5Σ+0.7σ calculated CTV-PTV margin.Results 30 patients were received 494 MVCT images.The errors of systemic±random were (2.85±0.77) mm,(3.11±0.95) mm,(2.21±0.55) mm,and (0,55±0.24)° on X,Y,Z and Roll directions,respectively.The CTV-PTV margins were 3.64 mm,4.17 mm,and 2.86 mm on X,Y,Z directions,respectively.Conclusion The application of image-guided technology for bone metastases can correct positioning in time,which greatly reduces setup errors of the fractionated treatment,further improves the treat accuracy and has a positive value in guiding clinical radiotherapy.