Objective To explore the ArcCHECK system-based methods for dose verification of ultra-long target for cervical cancer VMAT so as to assure the precision of cervical cancer radiotherapy.Methods A total of 33 patients with ultra-long target(target length≥26 cm)admitted to some hospital for cervical cancer VMAT from 2021 to 2023 were selected retrospectively,and radiotherapy plans were designed for the patients with VMAT technology and verified dosimetrically with different methods.Firstly,the dose distribution data were collected respectively at 5 and 8 cm away from the center of the ArcCHECK system along the bed exit direction,and enrolled into Group Test 1 and Test 2 respectively.Then the ArcCHECK system was flipped 180°,and the dose distribution data were acquired at 8 cm away from the center along the bed exit direction and included into Group Test 3.Dose merging between Group Test 2 and Test 3 with the Merge function was carried out to obtain the dose distribution data which were divided into Group Test 4.The monitor units of Group Test 1,2 and 4 were summarized,and difference analyses were performed on the length of the target area,detection point and irradiation time.Group Test 1,2 and 4 were compared in terms of γ pass rate,normalized dose deviation,confidence limit(CL)of pass rate and acceptance rate(γ pass rate≥95%and γ pass rate≥90%).Spearman's correlation coefficient was used to correlate the parameters such as maximum transverse diameter,length,volume and monitor unit of the target area and expected execution time of the plan.SPSS 19.0 software was used for statistical analysis.Results Group Test 1,2 and 4 had the monitor unit being(758.76±107.63)MU,and had statistically significant differences in length of the target area,detection point and irradiation time(P<0.01).In Group Test 4 γ pass rate under 2%/2 mm criterion did not reach 90%,and in Group Test 1 and 2 γ pass rates under 3%/3 mm and 3%/2 mm criteria both amounted to 95%.Group Test 1,2 and 4 had statistically significant differences in γ pass rate and normalized dose deviation(all P<0.05).In Group Test 1 there were more than 90%of the verification results where γ pass rate≥95%and more than 95%where γ pass rate≥90%under 3%/3 mm criterion.The monitor unit was positively correlated with the maximum transverse diameter,length and volume of the target area,respectively(0.337≤r≤0.568,P<0.05),and the expected execution time of the plan was positively correlated with the volume and monitor unit of the target area,respectively(0.457≤r≤0.517,P<0.01).Conclusion The dose verification method with the target at 5 cm away from the center along the bed exit direction can be applied clinically with high feasibility to the dose verification during the radiotherapy of the cervical cancer VMAT patients with ultra-long target,with the safety of the verification devices ensured effectively.

Objective To explore the ArcCHECK system-based methods for dose verification of ultra-long target for cervical cancer VMAT so as to assure the precision of cervical cancer radiotherapy.Methods A total of 33 patients with ultra-long target(target length≥26 cm)admitted to some hospital for cervical cancer VMAT from 2021 to 2023 were selected retrospectively,and radiotherapy plans were designed for the patients with VMAT technology and verified dosimetrically with different methods.Firstly,the dose distribution data were collected respectively at 5 and 8 cm away from the center of the ArcCHECK system along the bed exit direction,and enrolled into Group Test 1 and Test 2 respectively.Then the ArcCHECK system was flipped 180°,and the dose distribution data were acquired at 8 cm away from the center along the bed exit direction and included into Group Test 3.Dose merging between Group Test 2 and Test 3 with the Merge function was carried out to obtain the dose distribution data which were divided into Group Test 4.The monitor units of Group Test 1,2 and 4 were summarized,and difference analyses were performed on the length of the target area,detection point and irradiation time.Group Test 1,2 and 4 were compared in terms of γ pass rate,normalized dose deviation,confidence limit(CL)of pass rate and acceptance rate(γ pass rate≥95%and γ pass rate≥90%).Spearman's correlation coefficient was used to correlate the parameters such as maximum transverse diameter,length,volume and monitor unit of the target area and expected execution time of the plan.SPSS 19.0 software was used for statistical analysis.Results Group Test 1,2 and 4 had the monitor unit being(758.76±107.63)MU,and had statistically significant differences in length of the target area,detection point and irradiation time(P<0.01).In Group Test 4 γ pass rate under 2%/2 mm criterion did not reach 90%,and in Group Test 1 and 2 γ pass rates under 3%/3 mm and 3%/2 mm criteria both amounted to 95%.Group Test 1,2 and 4 had statistically significant differences in γ pass rate and normalized dose deviation(all P<0.05).In Group Test 1 there were more than 90%of the verification results where γ pass rate≥95%and more than 95%where γ pass rate≥90%under 3%/3 mm criterion.The monitor unit was positively correlated with the maximum transverse diameter,length and volume of the target area,respectively(0.337≤r≤0.568,P<0.05),and the expected execution time of the plan was positively correlated with the volume and monitor unit of the target area,respectively(0.457≤r≤0.517,P<0.01).Conclusion The dose verification method with the target at 5 cm away from the center along the bed exit direction can be applied clinically with high feasibility to the dose verification during the radiotherapy of the cervical cancer VMAT patients with ultra-long target,with the safety of the verification devices ensured effectively.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective To compare the pharmaceutics and drug interactions of noiiglutide injection,INS068 injection,HR17031 Injection,and noiiglutide+INS068 injection in healthy subjects Methods This was a single center,randomized,open-label,4-cycle,4-cohort trial.Healthy subjects were allocated to 4 groups randomly.HR17031(17 U/0.04 mg),INS068(17 U),noliglycopeptide(0.04 mg),and INS068(17 U)combined with noiiglutide(0.04 mg)were injected subcutaneously into the abdomenon on day 1,8,15 and 22 respectively.Venous blood was collected at different timing before and after administration,and the concentrations of noiiglutide in plasma and INS068 in serum were measured by HPLC-MS/MS method.Relevant pharmacokinetic parameters were calculated using the WinNonlin non compartment model.Results In HR17031,INS068,and INS068 combined with noiiglutide groups,the main pharmacokinetic parameters of INS068 in serum were calculated and listed as follows:Cmax were(19.50±4.06),(18.10±4.56)and(18.40±5.81)ng·mL-1,tmax was 12,10 and 8 h,t1/2 was(9.27±1.70),(11.00±2.81)and(11.0±3.18)h,AUC0-twere(505.00±62.20),(498.00±70.50)and(491.00±74.20)ng·mL-1·h.In HR17031,noiiglutide,and INS068 combined with noiiglutide groups,the main pharmacokinetic parameters of noiiglutide in plasma were calculated and listed as follows:Cmax were(3.61±0.82),(4.63±0.87)and(4.54±0.86)ng·mL-1,tmax was all 8.00 h,t1/2 was(10.50±1.61),(9.49±1.40)and(9.55±1.61)h,AUC0-twere(94.30±20.10),(106.00±20.20)and(105.00±19.00)ng·mL-1·h.Conclusion There was no significant difference in bioavailability of INS068 and noiiglutide in HR17031 compared with INS068 and noiiglutide whether combined or used alone.

Objective:To study the clinical value of combined indocyanine green fluorescence labeling method in sentinel lymph node biopsy on patients with thyroid carcinoma.Methods:Patients of thyroid tumor in our hospital from January 2016 to August 2017 were selected as the research,object 99 cases of thyroid benign tumor patients were randomly selected as the control group,99 cases of thyroid carcinoma patients were randomly selected as the observation group.According to the random number table method,patients in the group were randomly divided into A,B and C three groups,33 cases in each group.Group A were used 1.25mg/mL indocyanine green as a fluorescent tracer,group B were used 2.5mg/mL indocyanine green as a fluorescent tracer,group C were used 5mg/mL indocyanine green as fluorescent tracer to tracer for sentinel lymph node biopsy.The detection rate of sentinel lymph node and the average number of sentinel lymph nodes of each group were compared,and the false negative rate,sensitivity and accuracy of each group were also compared.Results:The detection rate of anterior sentinel lymph node in the group B was higher nan that in the group A and group C (P＜0.05).The average number of sentinel lymph nodes in the group B was significantly higher than that in the control group A and group C(P＜0.05).The false negative rate and sensitivity of the group B were significantly better than those of the group A and group C(P＜0.05).Conclusion:Indocyanine green fluorescent tracer method in sentinel lymph node biopsy has high detection rate of sentinel lymph node and detection range and high sensitivity advantage for patients with thyroid carcinoma,which has important clinical value for improving the operation methods,it is worth in clinical promotion.

Objective To evaluate the accuracy of corneal power mea-surements by a rotating scheimpflug camera ( Pentacam ) in eyes after myopic excimer laser surgery .Methods This prospective comparative interventional case series comprised 19 eyes of 15 patients who had myopic excimer laser surgery.Used Pentacam, clinical history method and IOL -Master measured keratometry reading .The median absolute error ( MedAE ) , the mean absolute error ( MAE ) and postoperative re-fractive error were compared among three methods.Results MedAE and MAE of Pentacam EKR method were significantly lower than those of clinical history and IOL -Master methods ( P <0.05 ) . Keratometry reading were significantly lower than that of IOL -Maste method (P<0.05).During the ±0.25 D, ±0.50 D, ±1.00 D range, eye number ratio of EKR method was significantly higher than that of IOL-Master method ( P<0.05 ). Conclusion Pentacam EKR can accurately measure the intraocular lens power .When historical refractive data are not available , scheimpflug imaging with the Pentacam provides an alternative method of measuring the central corneal power in eyes that previously received corneal refractive surgery.

Objective To find the changes of haemagglutination inhibition ( HI ) antibody level against A/California/07/2009 (H1N1) within one month after pandemic A/H1N1 influenza vaccine (A/H1N1InfV) vaccination, and to provide data for drawing up immunization protocols against novel influenza . Methods The HI antibodies against A/California/07/2009 (H1N1) in sera from the inoculated subjects were tested by HI test .The geometric mean titer ( GMT) , geometric mean increase ( GMI) , seroconversion (SC) rate, seroprotection (SP) rate of HI antibodies were compared among the sera collected on day 3, 7, 14, 30 post vaccination .Results 961 participants were injected with A/H1N1InfV.In subjects aged 3 to 11 years, the antibody level peaked on day 14 post vaccination, but neither on day 14 nor on day 30, the lower bound of the two -sided 95%CI for the SP rate could fulfill the criteria of the FDA for influenza vac-cine.In subjects aged 12 to 60 years, the antibody level peaked on day 14 post vaccination and the SC rate , SP rate and GMI fulfilled the criteria of the European Medicines Agency ( EMEA) and the FDA for influenza vaccine. In subjects aged more than 60 years, the antibody level peaked on day 30 post vaccination , and the SC rate, SP rate and GMI on day 30 fulfilled the criteria of the EMEA and the FDA .Conclusion One dose A/H1N1InfV vaccination was able to induce enough protection on day 14 for subjects aged 12 to 60 years, on day 30 for subjects aged more than 60 years;however , for subjects aged 3 to 11 years who were antibody-negative at baseline , the lower bound of the two-sided 95%CI for the SP rate on day 14 and day 30 couldn′t fulfill the criteria of the FDA for influenza vaccine .

OBJECTIVETo construct a recombinant plasmid pIRES-GM-CSF-IL-21, and to investigate its antitumor effect on tumors in the mice.

METHODSFifty Bal b/c mice were included in this study. Cultured hepatoma H22 cells were inoculated in the left lobe of the liver to develop orthotopically transplanted liver tumor models. The mice with orthotopically transplanted liver tumor were randomly divided into 5 groups (n = 10): (1) Each mouse received injection of recombinant plasmid pIRES-GM-CSF-IL-21; (2) Received injection of plasmid pIRES-GM-CSF; (3) pIRES-IL-21; (4) Received injection of ampty plasmid pIRES (H22/neo group); (5) Received injection of PBS (H22 group) via the tail vein, respectively. Therefore, the anti-tumor effect was induced by both GM-CSF and IL-21, or by either of them alone. The serum levels of IFN-γ and IL-2 were detected by ELISA, and the cytotoxicity of spleen NK and CTL cells were tested by MTT colorimetry.

RESULTSComparing with the H22 and H22/Neo groups, the tumor weight in the mice of H22/GM-CSF group was (0.603 ± 0.223) g, H22/IL21-treated group (0.583 ± 0.290) g and H22/GM-CSF-IL21-treated group (0.303 ± 0.323) g, significantly lower than that in the H22 group [(1.591 ± 0.280) g] and H22/Neo group [(1.489 ± 0.155) g]. Among them the tumor growth was most significantly inhibited in the H22/GM-CSF-IL-21 group (0.303 ± 0.323) g, compared with that of H22 and H22/neo groups (P < 0.01). But there was no significant difference between the tumor weights of the H22/GM-CSF group and H22/IL-21 group, and between the tumor weights of the H22 and H22/Neo groups (P > 0.05). The levels of IFN-γ and IL-2 in peripheral blood of mouse models treated with H22/GM-CSF-IL-21 were significantly increased than that in the H22/GM-CSF group and H22/IL-21 group (all P < 0.01), but significantly decreased in the H22group and H22/Neo group (P < 0.01). The anti-tumor activity of splenic NK cells and CTLs in the H22/GM-CSF-IL21 group was significantly enhanced (P < 0.01), compared with the significantly decreased in the H22 and H22/Neo groups.

CONCLUSIONSOur results demonstrate apparent antitumor effect of the plasmid pIRES-GM-CSF-IL-21 on the orthotopically transplanted liver tumor in mice. The combination of both pIRES-GM-CSF and IL-21 is more effective than that of pIRES/IL21 or pIRES/GM-CSF treatment alone. In addition, the plasmid pIRES-GM-CSF-IL-21 can also promote the secretion of IFN-γ and IL-2 in vivo, and enhance the cytotoxic activity of splenic NK and CTLs against the transplanted liver tumor.

Animals ; Carcinoma, Hepatocellular ; blood ; pathology ; therapy ; Cell Line, Tumor ; Female ; Granulocyte-Macrophage Colony-Stimulating Factor ; genetics ; Immunotherapy ; Interferon-gamma ; blood ; Interleukin-2 ; blood ; Interleukins ; genetics ; Killer Cells, Natural ; immunology ; Liver Neoplasms ; blood ; pathology ; therapy ; Mice ; Mice, Inbred BALB C ; Neoplasm Transplantation ; Plasmids ; therapeutic use ; Random Allocation ; Recombinant Proteins ; therapeutic use ; T-Lymphocytes, Cytotoxic ; immunology ; Tumor Burden

BACKGROUNDTransplantation of mensenchymal stem cells (MSCs) has been proposed as a promising way for tissue engineering. However, the application of MSCs for transplantation will undergo apoptosis due to the extremely harsh microenvironment such as excessive inflammation. Apigenin (API) has been reported to protect cells against inflammatory damage and cell death by exhibiting anti-inflammatory and anti-oxidative capacity. Here we investigated the modulatory effects of API in lipopolysaccharide (LPS)-mediated inflammation and apoptosis of MSCs, and further defined the underlying mechanism.

METHODSEffects of different concentrations of API (0, 5, 10, 20, 40 and 80 µmol/L) for 24 hours, and LPS (0, 0.5 and 5.0 µg/ml) for 6 hours and 24 hours on MSCs viability were assayed by MTT. Based on this, MSCs were pretreated with different concentrations of API (0 - 40 µmol/L) at the indicated times (6, 12 and 24 hours) followed by exposure to 5 µg/ml LPS for 24 hours. MTT, phase-contrast microscopy, annexinV/propidium iodide (PI) double stain flow cytometry (FCM) and Hoechst staining were applied to explore the effects of API on MSCs induced by 5 µg/ml LPS for 24 hours. In addition, reverse-transcription polymerase chain reaction (RT-PCR) was applied to detect the mRNA expression of pro-inflammatory factors including cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), nuclear factor-kappa B (NF-κB), pro-apoptotic gene caspase-3, Bad, and anti-apoptotic gene Bcl-2. Moreover, AutoDock software was used to imitate the docking score of API and vitamin D receptor (VDR). In parallel, Western blotting and RT-PCR were used to investigate protein and mRNA expression of VDR.

RESULTSMSCs stimulated with LPS 5 µg/ml for 24 hours was used as a model of apoptosis induced by over inflammatory stimulus. API (0 - 40 µmol/L) had non-toxic effect on MSCs; however, it could decrease mRNA expression of COX-2, iNOS and NF-κB at different time points in MSCs induced by LPS, except for API at the concentration of 5 µmol/L.

RESULTSfrom phase-contrast microscopy, MTT, Hoechst staining and AnnexinV/PI double stain FCM demonstrated that with the increasing concentrations of API and extension of administrating time, significant morphological changes of MSCs occurred, viability of cells was strongly inhibited, and meanwhile, apoptosis of LPS-administrated MSCs was exacerbated, compared with LPS individual group. In addition, API promoted caspase-3, Bad mRNA expression and inhibited Bcl-2 mRNA expression in a time-dependent and concentration- dependent manner. Further study found that pro-apoptosis effect of API was related to suppress VDR expression.

CONCLUSIONSAPI could inhibit the expression of inducible inflammatory factors, therefore exert the strong anti-inflammatory function. However, API could not protect MSC apoptosis induced by LPS but amplified the apoptosis. The apoptosis is related to Bad/Bcl-2 increasing and caspase-3 activation, which is mediated through suppressing VDR expression.

Animals ; Apigenin ; pharmacology ; Apoptosis ; drug effects ; Blotting, Western ; Cell Survival ; drug effects ; Cells, Cultured ; Flow Cytometry ; Lipopolysaccharides ; pharmacology ; Male ; Mesenchymal Stromal Cells ; cytology ; drug effects ; metabolism ; Rats ; Rats, Sprague-Dawley ; Receptors, Calcitriol ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction