Objective:To compare four postmastectomy radiotherapy plans with different arc angles for left-sided breast cancer prepared using deep inspiration breath hold (DIBH) technique, in order to explore the feasibility of selecting optimal arc angles based on the parameters of patients′ anatomical structures.Methods:A total of 51 patients who underwent postmastectomy radiotherapy for left-sided breast cancer using DIBH at the Second Affiliated Hospital of Guangxi Medical University and the First Affiliated Hospital of Guangzhou Medical University were selected. Among these, 40 patients selected using simple random sampling were treated with four radiotherapy plans with different arc angles, labeled as SV120, SV100, SV80, and SV60, while the remaining 11 patients were treated with only the SV60 plans. The dose parameters of the target volumes (TVs) and organs at risk (the heart, lungs, and contralateral breast), as well as the beam-on times of individual arcs, in these plans were compared. The parameters of the anatomical structures (i.e., the heart, lung, and breast) of the 51 patients, including PHeart, PLungl, and PBreast, were extracted. Taking these parameters as independent variables and the quality of the SV60 plans as the dependent variable, fitting was conducted using P(SV60)—a multivariate logistic regression model—based on a training set (45 patients) and a testing set (six patients). The classification threshold of the plans was set at 0.5. Results:As the arc angle increased, the plans exhibited improved modulation capabilities for TVs and the left lung. However, the V5 of the right lung and the average beam-on time of a single arc also increased. The SV120 plans demonstrated significantly better V107% of planning target volume (PTV; 6.84%), homogeneity index (HI; 0.13), conformity index (CI; 0.81), and mean dose to the left lung (1 330.97 cGy) compared to the other three types of plans, with statistically significant differences ( W = 0-99, P < 0.001). The SV60 plans displayed lower mean doses to the contralateral breast (198.97 cGy) and the heart (440.35 cGy) and lower V5 of the right lung (0.27%) than the other three types of plans, with significant differences in V5 of the right lung and the mean dose to the contralateral breast ( W = 0-157, P < 0.001). In contrast, no significant difference was observed in these parameters (except for V5 of the right lung) among the other three types of plans. The four types of plans exhibited average beam-on times of individual arcs of 22.0, 19.1, 16.1, and 14.4 s, respectively, with statistically significant differences ( χ2= 93.0, P < 0.001). A multivariate logistic regression model revealed that PLungl, PHeart, and PBreast were negatively correlated with the quality of the SV60 plans ( t = -64.84, -28.20, -24.45, P<0.001). This model yielded an accuracy of 93.33% and a precision of 92.86% in the training set, while its accuracy and precision reached 100% in the testing set. Conclusions:For patients treated with postmastectomy radiotherapy for left-sided breast cancer using DIBH, it is feasible to select appropriate arc angles based on patients’ anatomical structures.

Objective:To compare four postmastectomy radiotherapy plans with different arc angles for left-sided breast cancer prepared using deep inspiration breath hold (DIBH) technique, in order to explore the feasibility of selecting optimal arc angles based on the parameters of patients′ anatomical structures.Methods:A total of 51 patients who underwent postmastectomy radiotherapy for left-sided breast cancer using DIBH at the Second Affiliated Hospital of Guangxi Medical University and the First Affiliated Hospital of Guangzhou Medical University were selected. Among these, 40 patients selected using simple random sampling were treated with four radiotherapy plans with different arc angles, labeled as SV120, SV100, SV80, and SV60, while the remaining 11 patients were treated with only the SV60 plans. The dose parameters of the target volumes (TVs) and organs at risk (the heart, lungs, and contralateral breast), as well as the beam-on times of individual arcs, in these plans were compared. The parameters of the anatomical structures (i.e., the heart, lung, and breast) of the 51 patients, including PHeart, PLungl, and PBreast, were extracted. Taking these parameters as independent variables and the quality of the SV60 plans as the dependent variable, fitting was conducted using P(SV60)—a multivariate logistic regression model—based on a training set (45 patients) and a testing set (six patients). The classification threshold of the plans was set at 0.5. Results:As the arc angle increased, the plans exhibited improved modulation capabilities for TVs and the left lung. However, the V5 of the right lung and the average beam-on time of a single arc also increased. The SV120 plans demonstrated significantly better V107% of planning target volume (PTV; 6.84%), homogeneity index (HI; 0.13), conformity index (CI; 0.81), and mean dose to the left lung (1 330.97 cGy) compared to the other three types of plans, with statistically significant differences ( W = 0-99, P < 0.001). The SV60 plans displayed lower mean doses to the contralateral breast (198.97 cGy) and the heart (440.35 cGy) and lower V5 of the right lung (0.27%) than the other three types of plans, with significant differences in V5 of the right lung and the mean dose to the contralateral breast ( W = 0-157, P < 0.001). In contrast, no significant difference was observed in these parameters (except for V5 of the right lung) among the other three types of plans. The four types of plans exhibited average beam-on times of individual arcs of 22.0, 19.1, 16.1, and 14.4 s, respectively, with statistically significant differences ( χ2= 93.0, P < 0.001). A multivariate logistic regression model revealed that PLungl, PHeart, and PBreast were negatively correlated with the quality of the SV60 plans ( t = -64.84, -28.20, -24.45, P<0.001). This model yielded an accuracy of 93.33% and a precision of 92.86% in the training set, while its accuracy and precision reached 100% in the testing set. Conclusions:For patients treated with postmastectomy radiotherapy for left-sided breast cancer using DIBH, it is feasible to select appropriate arc angles based on patients’ anatomical structures.

Skin wounds are global public problems,especially in terms of the difficult healing of chronic wounds,which may seriously affect patients'lives.Most skin-wound animal models are currently established by physical method,and different animal models have different biological characteristics.This review therefore classifies mouse,rat,and other animal models of skin wounds according to the literature,summarizes and analyzes the construction of skin-wound animal models based on physical method and evaluation indicators,and considers the advantages and disadvantages of different animal models,to provide a basis for the rational construction of skin-wound animal models and drug research and development.

OBJECTIVE: To explore the correlation between microRNA (miRNA) differential expression and quality of embryo. METHODS: The miRNA expression profiles of 8 blastocysts were detected by a TaqMan microRNA array, and miRNAs with a stable expression were selected. Additional blastocysts were selected, and the candidate miRNA was detected by real-time PCR. Meanwhile, chromosomal abnormalities of the embryos were detected by using next-generation sequencing, and the results were compared. RESULTS: The expression of mir-720, mir-372, mir-886-3p and mir-512-3p was higher than that of miR-145, which suggested that mir-720, mir-372, mir-886-3p and mir-512-3p are related to early embryo development. The expression of miR-145 and mir-886-3p were significantly lower in the normal chromosome group. With the threshold values of above 9 and 3 for the relative expression of miR-145 and mir-886-3p, respectively, there was no embryo without a chromosomal abnormality. CONCLUSION There is a correlation between the expression level of specific miRNA and chromosomal abnormalities of embryos, which may be used as a novel biomarker for embryo selection.

To investigate the DNA methylation in ZNF772 promoter region and its mRNA and protein expressions and analyze the clinical significance of DNA methylation of ZNF772 gene in cervical cancer. Cervical squamous cell carcinoma (SCC) tissues were harvested from three patients (SCC group),and normal cervical tissues from healthy individuals of the same age were used as the control group. Hyper-methylation and lower transcripts were screened by whole-genome bisulfite sequencing (WGBS) and RNA sequencing. Furthermore,in 40 cervical tissue samples in SCC group and 45 normal cervical tissues in the control group,DNA methylation status and mRNA expression of ZNF772 were measured by using real-time quantitative polymerase chain reaction (RT-qPCR) and bisulfite sequencing polymerase chain reaction (BSP). The protein expression was detected by immunohistochemistry. In the SCC group,the potential relationships of DNA methylation status in ZNF772 promoter and mRNA expression with the clinicopathological parameters of cervical cancer were analyzed. As shown by WGBS and RNA sequencing,the abnormal DNA methylated gene ZNF772 was associated with mRNA expression. RT-qPCR verified that the mRNA expression of ZNF772 was significantly lower in SCC group than in control group (=8.351,=0.016). Immunohistochemistry further confirmed that the positive expression of ZNF772 protein was down-regulated in SCC group (=3.802,=0.005). BSP showed that the DNA methylation rate of ZNF772 promoter region (-420,-422 locus) in SCC group was significantly higher than that in control group (=8.566,=0.038;=6.332,=0.043). Spearman correlation analysis showed that,in SCC group,DNA hypermethylation in ZNF772 promoter was negatively correlated with the mRNA expression (=-0.351,=0.045;=-0.349,=0.032) and was significantly correlated with HPV16/18 infection,tumor size,World Health Organization pathological grade,and International Federation of Gynecology and Obstetrics clinical stage (=0.018,=0.012,=0.009,and =0.035,respectively). The DNA hypermethylation in the promoter region of ZNF772 gene is involved in the occurrence and development of cervical cancer.
Cell Line, Tumor ; DNA Methylation ; DNA-Binding Proteins ; genetics ; Female ; Gene Expression Regulation, Neoplastic ; Human papillomavirus 16 ; Human papillomavirus 18 ; Humans ; Promoter Regions, Genetic ; Uterine Cervical Neoplasms ; genetics ; Zinc Fingers

Objective: To observe the safety and efficacy of fecal microbiota transplantation (FMT) in treatment of Parkinson′s disease (PD) with constipation. Methods: From September 2017 to April 2019, 22 PD patients with serious constipation in the Department of Neurology, the Affiliated Huaian No. 1 People′s Hospital of Nanjing Medical University were treated with FMT and followed up for 12 weeks. Spontaneous bowel movement (SBM) per week and scores of Wexner Constipation Scale (Wexner), Constipation Quality of Life Scale (PAC-QOL) and Parkinson′s Disease Quality of Life Questionnaire (PDQ-39) were recorded before and after transplantation. Results: Compared with the number of independent defecation and scores before treatment, the number of independent defecation per week (4.63±2.25, 5.38±1.23, 5.75±1.29, 5.54±1.30 vs 1.57±0.74), Wexner score (7.92±2.61, 5.67±1.78, 5.08±1.83, 4.92±1.78 vs 16.67±4.31), PAC-QOL score (62.3±3.2, 58.8±2.8, 57.1±3.9, 59.6±4.4 vs 110.3±14.7) and PDQ-39 score (44.8±14.8, 37.8±12.8, 32.8±12.3, 31.9±9.2 vs 58.7±16.7) were significantly improved by FMT treatment at two, four, eight and 12 weeks (P<0.01). After 12-week treatment, the effective rate was 100% (22/22), and the clinical cure rate was 86% (19/22). No serious adverse reactions occurred during treatment. Conclusion FMT is effective and safe in treating PD with constipation.

Background:The Food and Drug Administration recently announced that the use of morcellation may cause fibroids or pelvic dissemination and metastasis of uterine sarcoma;therefore,the use of morcellation is limited in the USA.A large sample study is necessary to assess the proportion of uterine malignant tumors found in patients with laparoscopic myomectomy.Methods:A national multicenter study was performed in China.From 2002 to 2014,33,723 cases were retrospectively selected.We calculated the prevalence and recorded the clinical characteristics of the patients with malignancy after morcellation application.A total of 62 cases were finally pathologically confirmed as malignant postoperatively.Additionally,the medical records of the 62 patients were analyzed in details.Results:The proportion of postoperative malignancy after morcellation application was 0.18％ (62/33,723) for patients who underwent laparoscopic myomectomy.Nearly 62.9％ (39/62) of patients had demonstrated blood flow signals in the uterine fibroids before surgery.And,23 (37.1％) patients showed rapid growth at the final preoperative ultrasound.With respect to the pathological types,38 (61.3％) patients had detectable endometrial stromal sarcoma,13 (21.0％) had detectable uterine leiomyosarcoma,only 3 (3.2％) had detectable carcinosarcoma,and 5 (8.1％) patients with leiomyoma had an undetermined malignant potential.Conclusions:The proportion of malignancy is low after using morcellation in patients who undergo laparoscopic myomectomy.Patients with fast-growing uterine fibroids and abnormal ultrasonic tumor blood flow should be considered for malignant potential,and morcellation should be avoided.

Objective To investigate the value of chloride clearance test in differential diagnosis of Gitelman syndrome (GS). Methods For patients with hypokalemic metabolic alkalosis and highly suspected GS,clinical data were documented and SLC12A3 gene screening was performed as gold standard to diagnose GS. Hydrochlorothiazide (HCT) test and furosemide (FUR) test were performed according to the standard process. Baseline and maximal increasement of chloride excretion fraction (FECl,the net and relative increase measured as εFECl) were compared between patients and controls to evaluated the reaction to the corresponding diuretics. Receiver operating characteristic (ROC) curve was used to evaluate the sensitivity and specificity of HCT test in GS diagnosis. Results Totally 27 patients and 20 health controls received HCT test. Among those patients,23 were diagnosed with GS genetically. When using the net and relative εFECl to diagnose GS,the areas under the ROC curve were 0.987 (95% CI:0.963～1.000,P<0.001) and 0.984 (95%CI:0.950～1.000,P<0.001),respectively. When a reasonable cutoff value for εFECl was selected,the sensitivity and specificity were both higher than 95%. Eight patients received both HCT test and FUR test. Five of them showed decreased reaction to HCT(net εFECl≤2.86% or relative εFECl≤223%),while normal reaction to FUR.SLC12A3 mutations confirmed their GS. Three patients with blunt reaction to FUR showed normal reaction to HCT,finally they were diagnosed as BS clinically because no SLC12A3 gene mutation was detected. Conclusion Comprehensive application of HCT test and FUR test to evaluate the diuretic reaction can effectively differentiate GS and BS.
Case-Control Studies ; Chlorides ; metabolism ; Diagnosis, Differential ; Gitelman Syndrome ; diagnosis ; Humans ; Hydrochlorothiazide ; Kinetics ; Mutation ; ROC Curve ; Sensitivity and Specificity ; Solute Carrier Family 12, Member 3 ; genetics ; metabolism

The study was aimed to investigate the effects of total saponins of Panax notoginseng (tPNS) on cobalt chloride (CoCl2)-induced apoptosis of rat bone marrow mesenchymal stem cells (rBMSCs) and the underlying mechanism. rBMSCs were isolated by density gradient centrifugation from Sprague Dawley (SD) rats. After being incubated with different concentrations of tPNS (1, 10, 100 μg/mL) for 48 h, the rBMSCs were stained with EdU and PI for proliferation and cell cycle assay, respectively. CoCl2 group was treated with 300 μmol CoCl2 for 24 h, and different concentrations tPNS groups were treated with 300 μmol CoCl2 plus 1, 10 or 100 μg/mL tPNS. After Annexin V-FITC/PI staining, flow cytometry was applied to measure the cell apoptosis. For mitochondrial membrane potential assay, rhodamine123 and Hoechst33342 staining were used. qRT-PCR was applied to analyze gene expression of Bcl-2 family. The results showed that the proliferation rates of the three concentrations tPNS groups were all higher than that of the control group (all P < 0.05). Compared with control group, only 100 μg/mL tPNS group exhibited increased cell percentage of S and G2 phase. Compared with that in control group (without CoCl2), the apoptotic rate was increased by 14.2% in CoCl2 group. And the apoptotic rates were reduced by 14.4%, 12.8% and 13.9% in three concentrations tPNS groups, compared with that in CoCl2 group (all P < 0.01). CoCl2 could decrease the mitochondrial membrane potential, while different concentrations of tPNS reversed the inhibitory effect of CoCl2. Bcl-2 and Bcl-xl mRNA expressions in all tPNS groups were higher than those in CoCl2 group (all P < 0.05). Moreover, 10 and 100 μg/mL tPNS groups showed lower ratios of Bax/Bcl-2, compared with CoCl2 group. The results suggest that tPNS protects the rBMSCs against CoCl2-induced apoptosis through improving the cell mitochondrial membrane potential, up-regulating the expressions of anti-apoptosis genes Bcl-2 and Bcl-xl, and reducing the Bax/Bcl-2 gene expression ratio.
Animals ; Apoptosis ; Bone Marrow Cells ; Membrane Potential, Mitochondrial ; Mesenchymal Stromal Cells ; Mitochondria ; Panax notoginseng ; Rats ; Rats, Sprague-Dawley ; Saponins

OBJECTIVETo study the significance of toll-like receptors (TLR) -7 and -8 in the pathogenesis of infection caused by Enterovirus type 71 (EV71) through measuring the expression of TLR7 and TLR8 in brain and lung tissues from the death cases caused by EV71 infection.

METHODSNine children who died of EV71 infection (EV71 group) were selected as study subjects, and 7 children who died of accidents or non-infectious diseases were used as the control group. Brain and lung tissues from the death cases in both groups at autopsy were collected, and immunohistochemistry was applied to detect the expression of TLR7 and TLR8 in lung and brain tissues in both groups. Integrated optical density (IOD) was applied for semi-quantitative analysis of the expression of TLR7 and TLR8.

RESULTSImmunohistochemical results showed that the expression of TLR7 and TLR8 in lung and brain tissues was strongly positive in the EV71 group, and the IOD values in the EV71 group were also significantly higher than those in the control group (P<0.05). There was no significant difference in the expression of TLR7 and TLR8 between lung and brain tissues in the EV71 group (P>0.05).

CONCLUSIONSTLR7 and TLR8 are highly expressed in lung and brain tissues from the patients who die of severe EV71 infection, suggesting that TLR7 and TLR8 may be involved in the pathogenesis of brain and lung damages caused by severe EV71 infection.

Brain ; immunology ; Child ; Cytokines ; physiology ; Enterovirus A, Human ; Enterovirus Infections ; etiology ; immunology ; Humans ; Lung ; immunology ; Toll-Like Receptor 7 ; analysis ; physiology ; Toll-Like Receptor 8 ; analysis ; physiology