Objective To analyze the epidemiological characteristics and disease burden of drug-resistant tuberculosis cases among elderly patients in Wuhan.Methods Clinical data of elderly pa-tients with pulmonary tuberculosis in Wuhan from January 2019 to December 2022 were retrospectively analyzed.Sputum samples were collected for Mycobacterium tuberculosis isolation,and drug suscepti-bility testing was performed using the proportion method.The epidemiological characteristics of drug-resistant tuberculosis and the direct economic burden of the patients were analyzed.Results A total of 972 elderly patients with positive Mycobacterium tuberculosis tests were included.The overall tuberculosis drug resistance rate was 21.19％(206/972).Male,rural residence,lower education level(primary school or below)and retreatment history significantly increased the risk of developing drug-resistant tu-berculosis(P＜0.05).The direct economic burden for elderly patients with drug-resistant tuberculosis was 24,101.52(8,283.98,39,598.89)RMB,and the indirect economic burden was 1,858.64(528.66,3,085.26)RMB.Conclusion The incidence of drug resistance in elderly tuberculosis is high,and male,rural residence,low education level and tuberculosis retreatment are the risk factors for drug resistance in elderly tuberculosis,and their economic burden is heavy after drug resistance.

Objective　: To verify the feasibility of using a homemade lung phantom for quality control of Cyberknife by comparing the measurement results of the homemade lung phantom and CIRS dynamic phantom in E2E testing of Cyberknife lung tracking.  Methods　 : The patient treatment process was simulated, including CT positioning, plan design, irra- diation implementation, film scanning, and analysis using the homemade phantom and CIRS phantom. The two phantoms were measured five times using MLC under the S7 generation Cyberknife and five times using Iris under the M6 generation Cyberknife. The differences in measurement results between the two phantoms were analyzed using independent sample t-test. Results　: For the S7 generation Cyberknife, the statistical analysis of differences between the two phantoms in the detection values on the X-axis, Y-axis, Z-axis, and total deviation showed P values of 0.236, 0.175, 0.289, and 0.668, respect- ively. For the M6 generation Cyberknife, the statistical analysis showed P values of 0.880, 0.891, 0.573, and 0.433, respect- ively. The P values were all > 0.05. Therefore, there were no statistically significant differences in the detection results between the homemade lung phantom and the CIRS phantom under the S7 and M6 generation Cyberknife. The total deviation values were <1.5 mm. Conclusion　 The homemade lung phantom and CIRS phantom have consistent measurement results in the E2E testing of Cyberknife lung tracking and meet the requirements of Report of AAPM TG-135 and WS 667- 2019 standard. Therefore, the homemade lung phantom is feasible for clinical quality control of Cyberknife.

Objective To establish testing and evaluation methods for radiation shielding performance of a self-shielded radiotherapy system by measuring the radiation levels around the self-shielded head and neck radiotherapy system. Methods A total of 14 monitoring points were selected outside the restricted zone of the system. Under radiation conditions from five different fixed directions, an ion chamber survey meter was used to measure and identify the maximum ambient dose equivalent rate at the 14 points. The time-averaged dose rate was then calculated based on the workload. In accordance with relevant radiation protection standards, an instantaneous dose rate of 10 μSv/h and a time-averaged dose rate of 2.0 μSv/h were proposed as the criteria for shielding protection evaluation. Results Based on the ambient dose equivalent rates at the 14 monitoring points outside the restricted zone, the maximum instantaneous dose rate outside the restricted zone was 7.4 μSv/h. With a workload of 15 patients per day, the maximum time-averaged dose rate was 1.0 μSv/h, which can be used as the criteria for shielding protection evaluation. Conclusion By considering both instantaneous dose rate and time-averaged dose rate, a comprehensive safety assessment of the radiation shielding performance of a self-shielded radiotherapy system can be conducted.

Objective To investigate the role of the renin-angiotensin system(RAS)in the pathogenesis of acute kidney injury(AKI)after laparoscopic radical nephrectomy(LRN)and the predictive value of RAS activation status for AKI.Methods Eighty-two patients undergoing LRN at the Third Medical Center of General Hospital of PLA from December,2023 to March,2024 were enrolled,including 57 with postoperative AKI and 25 without AKI according to KDIGO criteria.Blood and urine samples were collected from the patients before and at 24 h after the operation for analyzing the correlation of urinary aldosterone,plasma ACE2,Ang1-7,Nrf-2,and IL-10 levels with postoperative AKI.Univariate and multivariate logistic regression analyses and ROC curve were employed to identify the risk factors for postoperative AKI and their predictive value for AKI.Results Compared with those without postoperative AKI,the patients with AKI had significantly higher postoperative urinary aldosterone levels and lower plasma ACE 2,Ang 1-7,Nrf-2,and IL-10 levels(P<0.05).Postoperative urinary aldosterone level was positively correlated with AKI and negatively with estimated glomerular filtration rate(eGFR)(P<0.05);plasma levels of ACE 2,Nrf-2,and IL-10 were all negatively correlated with AKI and positively with eGFR.Urinary aldosterone was a risk factor and plasma ACE 2,Ang 1-7,Nrf-2 and IL-10 were protective factors for AKI,and among them urinary aldosterone was an independent risk factor(AUC=0.651)and plasma Nrf-2 was an independent protective factor(AUC=0.679).The unconventional RAS pathway indices had an AUC of 0.758,and aldosterone combined with the unconventional pathway indices had an AUC of 0.788 for predicting postoperative AKI.Conclusion Activation of the conventional RAS pathway and suppression of the unconventional pathway contribute to AKI following LRA possibly by affecting eGFR.Aldosterone combined with the unconventional pathway indicators can predict the occurrence of AKI after LRN.

Objective To investigate the role of the renin-angiotensin system(RAS)in the pathogenesis of acute kidney injury(AKI)after laparoscopic radical nephrectomy(LRN)and the predictive value of RAS activation status for AKI.Methods Eighty-two patients undergoing LRN at the Third Medical Center of General Hospital of PLA from December,2023 to March,2024 were enrolled,including 57 with postoperative AKI and 25 without AKI according to KDIGO criteria.Blood and urine samples were collected from the patients before and at 24 h after the operation for analyzing the correlation of urinary aldosterone,plasma ACE2,Ang1-7,Nrf-2,and IL-10 levels with postoperative AKI.Univariate and multivariate logistic regression analyses and ROC curve were employed to identify the risk factors for postoperative AKI and their predictive value for AKI.Results Compared with those without postoperative AKI,the patients with AKI had significantly higher postoperative urinary aldosterone levels and lower plasma ACE 2,Ang 1-7,Nrf-2,and IL-10 levels(P<0.05).Postoperative urinary aldosterone level was positively correlated with AKI and negatively with estimated glomerular filtration rate(eGFR)(P<0.05);plasma levels of ACE 2,Nrf-2,and IL-10 were all negatively correlated with AKI and positively with eGFR.Urinary aldosterone was a risk factor and plasma ACE 2,Ang 1-7,Nrf-2 and IL-10 were protective factors for AKI,and among them urinary aldosterone was an independent risk factor(AUC=0.651)and plasma Nrf-2 was an independent protective factor(AUC=0.679).The unconventional RAS pathway indices had an AUC of 0.758,and aldosterone combined with the unconventional pathway indices had an AUC of 0.788 for predicting postoperative AKI.Conclusion Activation of the conventional RAS pathway and suppression of the unconventional pathway contribute to AKI following LRA possibly by affecting eGFR.Aldosterone combined with the unconventional pathway indicators can predict the occurrence of AKI after LRN.

Objective: To discuss the feasibility of applying home-made auto quality assurance (AQA) phantom in Cyberknife AQA test. Methods: The same treatment plan for AQA test was designed in the Cyberknife treatment planning system. The AQA tests were performed under the same conditions using the home-made AQA phantom and the AQA phantom in the fourth-generation (G4) Cyberknife mode and the fifth-generation (VSI) Cyberknife mode, respectively, and each measurement was repeated five times to analyze and compare the differences in test results between the two phantoms. Results: The total deviations of the home-made AQA phantom and the AQA phantom in the AQA test under the G4 Cy- berknife mode were (0.28 ± 0.12) mm and (0.28 ± 0.15) mm, respectively (P > 0.05); the test results under the VSI Cy- berknife mode were (0.46 ± 0.19) mm and (0.50 ± 0.07) mm, respectively (P > 0.05); the total deviations of all test results were smaller than 1.0 mm, which met the requirements of WS 667—2019 Specification for Testing of Quality Control in Ro- botic Arm Radiotherapy Device. Conclusion The test results of the home-made AQA phantom and the AQA phantom are consistent in the AQA test, and the home-made AQA phantom can be used for Cyberknife quality control.

Congenital hydrocephalus is a major neurological disorder with high rates of morbidity and mortality; however, the underlying cellular and molecular mechanisms remain largely unknown. Reproducible animal models mirroring both embryonic and postnatal hydrocephalus are also limited. Here, we describe a new mouse model of congenital hydrocephalus through knockout of β-catenin in Nkx2.1-expressing regional neural progenitors. Progressive ventriculomegaly and an enlarged brain were consistently observed in knockout mice from embryonic day 12.5 through to adulthood. Transcriptome profiling revealed severe dysfunctions in progenitor maintenance in the ventricular zone and therefore in cilium biogenesis after β-catenin knockout. Histological analyses also revealed an aberrant neuronal layout in both the ventral and dorsal telencephalon in hydrocephalic mice at both embryonic and postnatal stages. Thus, knockout of β-catenin in regional neural progenitors leads to congenital hydrocephalus and provides a reproducible animal model for studying pathological changes and developing therapeutic interventions for this devastating disease.
Animals ; Disease Models, Animal ; Hydrocephalus/genetics* ; Mice ; Mice, Knockout ; Neurons ; beta Catenin/genetics*

Objective:To observe ulcer characteristics of Crohn's disease under double balloon enteroscopy,and to evaluate the correlation between endoscopic severity and clinical manifestations.Methods:A prospective,observational study from July 2015 to December 2016 in the Third Xiangya Hospital,Central South University,we selected 45 patients with positive double-balloon enteroscopy (DBE) and confirmed Crohn's disease.Two digestive internal physician observed the ulcer characteristics of Crohn's disease under double balloon enteroscopy,and gave a simple endoscopic score for CD (SES-CD).We analyzed the correlation between SES-CD and Crohn's disease activity index (CDAI).Results:DBE indicated 24 patient ulcers (53.33％) locating at the end of the ileum,5 (11.11％)locating at ileocolon,16 (35.56％) locating at upper gatrointestinal tract and they did not affect the end of the ileum.Among them,8 cases (17.78％) affected only jejunum.Thirty-two patients with longitudinal ulcers in Crohn's disease,accounting for 71.11％.There was no correlation between SES-CD score and CDAI score (r=0.237,P=0.136).Conclusion:The ulcerative appearance in Crohn's disease were diverse under double balloon enteroscopy.Crohn's disease could only affect the upper gastrointestinal tract or jejunum.The unwounded ileum and ileocecal valve couldn't be a sign to exclude Crohn's disease.CDAI score couldn't fully assess the prognosis of Crohn's disease.

Objective:To analyze the change of bone mineral density (BMD) in postmenopausal women,and to study the relationship between BMD and the estrogen,cytokines,and serum levels of bone metabolism.Methods: 135 postmenopausal women were divided into the OP group (n=54),Osteopenia group (n=43) and normal group (n=38) according to the results of lumbar spine bone mineral density (BMD) scan.To detected the concentration of serum estradiol (E2),bone alkaline phosphatase (BALP) and osteocalcin (BGP),tartrate resistant acid phosphatase-5b (TRAP-5b),interleukin-6 (IL-6),tumor necrosis factor alpha (TNF-α),transforming growth factor beta (TGF-β1) and IL-10 of research objects in the three groups.And to analyze the relationship between BMD and the levels of E2,BALP,BGP,TRAP-5b,IL-6,TNF-α,TGF-β1 and IL-10.Results: In the OP group and the Osteopenia group,BMD and the levels of E2,TGF-β1 and IL-10 were obviously lower than that in the normal group (P<0.05),and the levels of BALP,BGP,TRAP-5b,IL-6 and TNF-α were obviously higher than that in the normal group (P<0.05).When compared with the Osteopenia group,the BMD and E2 level in the OP group was more lower (P<0.05),and the levels of BALP,BGP,TRAP-5b,IL-6 and TNF-α were more higher (P<0.05).E2 and TGF-β1 showed the significant positive correction with BMD (P<0.05),and the BALP,BGP,TRAP-5b,IL-6 and TNF-α were all negatively corrected with BMD (P<0.05).However,no significant difference of relevance was seen between IL-10 and BMD (P>0.05).The low serum E2 levels and high serum levels of BALP,BGP,TRAP-5b,IL-6 and TNF-α were the independent factors affecting the reduction of BMD (P<0.05).Conclusion: The E2 level in patients with PMOP decreased obviously,which caused the imbalance of bone remodeling and inflammatory reaction,and which was related to the decrease of BMD.

Objective To evaluate the clinical capability of young general practitioners (GPs) in communities in Shanghai.Methods A cross-sectional survey on clinical ability of young GPs was adopted from October to December 2014.Total 211 GPs aged (31 ± 2) years (25-35) from 17 districts of Shanghai participated in the study.Written examination and objective structured clinical examination (OSCE) was applied in the evaluation.Results All 211 GPs (63 male and 148 females) completed the assessment.The overall score of the assessment was (602 ± 83) and the pass rate was 62.6％ (132/211).In written examination the average score was (64 ±7) and the pass rate was 72.1％ (152/211).In OSCE,the highest score (80 ± 15) and pass rate (92.9％,196/211) was in CPR skill,followed by communication skill [average score:(76 ± 15) and pass rate:85.8％ (181/211)].The lowest average score was physical examination (47 ± 15) with a pass rate of 26.1％ (55/211),followed by electrocardiogram reading [average score:(84 ±31) and pass rate:39.8％ (84/211)].In basic operation station,the lowest score was using funduscope and gynecologial examination (29.8％ and 45.4％,respectively).Conclusion Young GPs in Shanghai communities basically master clinical skills,but also have some deficiencies,the training in certain skills need to be strengthened.