At present,precise radiotherapy has been widely used through the development with many years,but the existing technique still is limited by the limitation of tolerance dose of normal tissues,which cannot achieve the optimal goal of treating tumor.Flash radiotherapy(Flash-RT)is one kind of radiotherapy technique that uses the beam with ultra-high dose rate(UHDR)to conduct irradiation,which can furthest treat tumors while significantly reduce radiation injury of normal tissues.But until now,the biological mechanism,key physical parameters and triggering mechanism of Flash-RT are still unclear,and its principle and clinical translational application are still in the stage of research.This review clarified the technological advance and clinical translational application of Flash-RT research through summarized the relevant research of Flash-RT.

The Flash radiotherapy(Flash-RT),which is the key breakthrough in the basic field of radiotherapy technique,which is expected to cause a new major transformation in the field of radiotherapy.In this paper,we reviewed the latest research advances of the application and the mechanism exploration of Flash-RT in tumor treatment.Current studies have found that both the Flash-RT with electron beams and photon and the Flash-RT with proton can reduce injury of normal tissue than radiotherapy with conventional dose-rate,but the relevant mechanisms are not yet clearly understood,which includes but not limited to oxygen depletion,DNA damage,cellular senescence,apoptosis and immune response.The difference of Flash-RT injury between tumor tissue and normal tissue further reduces the limitations of radiotherapy,and reduces the adverse reaction and complication compared with conventional radiotherapy,which has wide application prospects.

Radiotherapy is an important means to treat lung cancer,but it is easy to cause lung injury and reduce the quality of life of patients.Flash radiotherapy(FLASH-RT)has attracted attention due to its extremely short radiation duration and high dose rate,which can reduce toxicity of normal tissue while ensures treatment intensity of tumor.Whether Flash-RT can reduce radiation-induced lung injury has become an important research topic in recent years.Based on the literature analysis method,this review systematically assessed the effects and mechanisms of Flash-RT and radiotherapy with conventional dose rate on lung injury through searching relevant literatures at home and abroad,so as to provide scientific basis for the treatment of patients with lung cancer by reviewing the comparisons about the effects and mechanisms between Flash-RT and radiotherapy with conventional dose rate on lung injury.Compared with radiotherapy with conventional radiation rate,Flash-RT can significantly reduce lung injury and improve quality of life of patients.It is still demanded to explore the Flash-RT mechanism in future,so as to develop the Flash-RT instrument that is suitable for different tumors and to conduct larger-scale clinical researches.

Objective To explore the mediating effect of triglyceride-glucose(TyG)index on the risk of proteinuria in patients with type 2 diabetes mellitus(T2DM).Methods 734 patients with T2DM who underwent routine physical examination in Quyang Road Community Health Service Center,Shanghai from March 2023 to May 2023 were enrolled.The results of basic information,biochemical indicators,abdominal ultrasound and other results were collected.All patients were divided into the normal group,microproteinuria group,and massiveproteinuria group,and stratification analyses were underwent according to glycated hemoglobin(HbA1c),body mass index(BMI),TyG index,and presence or absence of non-alcoholic fatty liver disease(NAFLD).Factors affecting proteinuria in T2DM patients were analyzed.Multivariate logistic regression was used to analyze the impact of TyG index and NAFLD on proteinuria in type 2 diabetes population.Regression coefficient sequential test was used to analyze whether TyG mediates NAFLD associated proteinuria.Results There were statistically significant differences in age,BMI,urinary creatinine,HbA1c,TyG index,etc.among the normal group,microproteinuria group,and massiveproteinuria group(all P＜0.05);there was no statistically significant difference in gender among the three groups.Multivariate logistic regression analysis showed that taking the HbA1c＜7％and BMI＜24 kg/m2 group as a reference,the patients with HbA1c≥7％and BMI≥24 kg/m2 had the highest risk of proteinuria(P=0.022),followed by the HbA1c≥7％and BMI＜24 kg/m2 group(P=0.039).Taking the TyG index(7.65-8.69)as a reference,the risk of proteinuria in the(9.45-11.90)group was 3.321 times(P＜0.001).The mediation effect analysis showed that the TyG mediated NAFLD associated proteinuria(P＜0.001),with the mediation effect accounting for 55.70％of the total effect.Conclusion TyG index may be an independent risk factor for proteinuria in patients with T2DM,and the prevalence of proteinuria is high in patients with poor control in HbA1c and excessive BMI,and TyG may partially mediate the risk of proteinuria in patients with T2DM.

Objective:To detect pathogenic mutation in a Chinese family affected with isolated bilateral microtia.Methods:During 2022 June to December, one Chinese Han family with non-syndromic bilateral microtia was recruited at the First Hospital of Shanxi Medical University. The clinical data and peripheral blood samples were collected from the family members. Whole genome sequencing (WGS) was performed in the proband to screen all candidate variants. Quantitative PCR was applied to identify the candidate copy number variation (CNV) among the proband, the unaffected wife and the affected son to demonstrate the association between candidate variant and phenotype.Results:The patients in the family had non-syndromic bilateral concha-type microtia. WGS detected the duplication in the intergenic region of HMX1 and CPZ gene in the proband, which involved the evolutionarily conserved region (ECR). Both the proband and his affected son carried the CNV, while his unaffected wife did not have this variation.Conclusion:Duplications involving the long range HMX1 enhancer ECR are associated with the bilateral concha-type microtia in this family.

Objective:To detect pathogenic mutation in a Chinese family affected with isolated bilateral microtia.Methods:During 2022 June to December, one Chinese Han family with non-syndromic bilateral microtia was recruited at the First Hospital of Shanxi Medical University. The clinical data and peripheral blood samples were collected from the family members. Whole genome sequencing (WGS) was performed in the proband to screen all candidate variants. Quantitative PCR was applied to identify the candidate copy number variation (CNV) among the proband, the unaffected wife and the affected son to demonstrate the association between candidate variant and phenotype.Results:The patients in the family had non-syndromic bilateral concha-type microtia. WGS detected the duplication in the intergenic region of HMX1 and CPZ gene in the proband, which involved the evolutionarily conserved region (ECR). Both the proband and his affected son carried the CNV, while his unaffected wife did not have this variation.Conclusion:Duplications involving the long range HMX1 enhancer ECR are associated with the bilateral concha-type microtia in this family.

Objective:To investigate the regulatory role of mesenchymal stem cells(MSCs)on radiation-induced lung injury in mice by the ferroptosis pathway.Methods:The mice were divided into normal control group,MSCs-treated group(MSCs group),single irradiation group(IR group)and IR combined with MSCs group(IR+MSCs group)according to random number table method before irradiation.A mouse model of radiation-induced lung injury was constructed using whole thorax irradiation with cobalt 60(60Co)(20Gy each time),and TNF-α and IL-6 levels of mouse were detected by enzyme-linked immunosorbent assay(ELISA).The injury of lung tissue in mice was assessed using hematoxylin eosin(HE)staining and Masson staining.Western Blot was used to examine the expression levels of ferroptosis-related proteins in lung tissue,including nuclear factor erythroid NF-E2 related factor 2(Nrf2),4-Hydroxynonenal(4-HNE)and glutathione peroxidase 4(GPX4).The expression level of prostaglandin-endoperoxide synthase 2 Gene(PTGS2)in the lung tissue of mice was detected by using quantitative polymerase chain reaction(qPCR),and the level of reactive oxygen species(ROS)in the lung tissue of mice was detected after radiation by using dihydroethidium(DHE),and the level of malondialdehyde(MDA)content in the lung tissue was detected after radiation.And then,the level of oxidative damage in the lung tissue of mice was assessed.Results:Elisa results showed the serum TNF-α and IL-6 levels in mice after irradiation in IR group were significantly higher than those in normal control group(F=53.60,10.65,P＜0.05),respectively.The HE and MSCs staining of pathological analysis showed that MSCs treatment could significantly relieve both early radiation-induced pneumonitis and advanced pulmonary fibrosis.After radiation,the 4-HNE expression level was upregulation and the Nrf2 expression level was downregulation in the lung tissues of mice,whereas MSCs were able to significantly reduce the 4-HNE expression and upregulate the Nrf2 expression.The mRNA expression level and MDA content of the ferroptosis gene PTGS2 were significantly increased,which were significantly higher than those of normal control group,while MSCs were able to significantly reduce its expression,and the differences were statistically significant(F=105.8,7.693,P＜0.05).Conclusion:MSCs is able to relieve significantly ionizing radiation-induced ferroptosis of lung epithelial cells,thereby relieve radiation-induced lung injury.

Objective:To construct an system of optimization and evaluation parameters for the archive management of medical equipment in hospital,and to optimize and improve the quality and effect of the management for the archive of medical equipment of hospital.Methods:The problems existing in the management of the archives of medical equipment in hospitals were analyzed,and the targeted measures were formulated on the basis of the optimization of management mode,the innovation of management process of the archives,the improvement of management system of archives and continuous improvement of the quality of management personnel of equipment archives.The indicator system of optimization and evaluation of the management of medical equipment archives of hospital was constructed from 6 secondary indicators included management mechanism and system construction,personnel training and capacity building,quality of archive management,efficiency of archives review,satisfaction survey of service object,and innovation ability,as well as 18 tertiary indicators under the secondary indicators.The scores of the secondary and tertiary indicators of the evaluation of indicator system between before and after the measures of indicator system of optimization and evaluation of archive management of medical equipment of Peking University School and Hospital of Stomatology were implemented were compared.Results:Before each measure that was formulated by the indicator system of optimization and evaluation of the archive management of medical equipment of hospital was implemented,the comprehensive evaluation score of archive management of medical equipment of hospital was 3.65 points.The comprehensive evaluation score was 4.9 points after the each measure was implemented.After the indicator system was implemented,the median scores of secondary and tertiary indicators were respectively 0.63(0.40-1.50)points and 0.25(0.13-0.50)points,which were all significantly higher than those before they were implemented,and the differences were all statistically significant(Z=-2.23,-3.22,P<0.05).Conclusion:The indicator system of optimization and evaluation of archive management of medical equipment of hospital can improve the quality and effect of archive management of medical equipment of hospital,and provide a basis and guarantee for the whole life cycle management of medical equipment such as procurement decision-making,quality control management,maintenance management,and scrap disposal of medical equipment of hospital.

ObjectiveTo establish the specific chromatogram and thin layer chromatography（TLC） identification method of Kaixinsan（KXS） samples， in order to clarify the key quality attributes and provide reference for the quality evaluation of KXS. MethodHigh performance liquid chromatography（HPLC） specific chromatogram of KXS was developed with YMC Hydrosphere C₁₈ column（4.6 mm×250 mm， 5 μm）， the mobile phase was acetonitrile（A）-0.2% formic acid aqueous solution（B） for gradient elution（0-15 min， 2%-20%A； 15-25 min， 20%-25%A； 25-30 min， 25%-30%A； 30-45 min， 30%-31%A； 45-50 min， 31%-44%A； 50-65 min， 44%-45%A； 65-73 min， 45%-75%A； 73-95 min， 75%-100%A； 95-105 min， 100%A； 105-105.1 min， 100%-2%A； 105.1-120 min， 2%A）， the detection wavelength was 320 nm. Ultra high performance liquid chromatography-linear ion trap-electrostatic field orbitrap mass spectrometry（UHPLC-LTQ-Orbitrap MS） was used to identify the chemical components of KXS with electrospray ionization（ESI）， negative ion mode and scanning range of m/z 50-2 000. TLC identification methods for Poria and Ginseng Radix et Rhizoma in KXS were established. ResultThere were 11 common peaks in the specific chromatogram of KXS， attributed to Polygalae Radix， Poria and Acori Tatarinowii Rhizoma. Taking peak 9（α-asarone） as the reference peak， the relative standard deviations of the retention times of 15 batches of KXS samples were<0.2%. A total of 34 compounds were identified by UHPLC-LTQ-Orbitrap MS， including terpenoids， phenylpropanoids， oligosaccharides and ketones. The established TLC had good separation and was rapid， reliable， simple， feasible， suitable for the identification of Poria and Ginseng Radix et Rhizoma in KXS. ConclusionThe specific chromatogram and TLC of KXS are stable and reproducible. The material basis of KXS is basically clarified by MS， which can provide a reference for the development and quality control of KXS.

Objective:To explore the abnormally low expression of regulatory T cells (Tregs) in the peripheral blood of patients with keloids, its correlation with the formation and evolution of keloids.Methods:A total of 50 peripheral blood samples of patients diagnosed with keloids were collected in the first diagnosis of Changzhi City People′s Hospital from January 2019 to January 2021 as keloid group, including 22 males and 28 females, with an age range of 18-55 years and an average age of 32.13 years; the control group was normal healthy beauty seekers in the outpatient department of Changzhi People′s Hospital during the same period, and finally 25 peripheral blood samples were also collected, including 15 males and 10 females, with an age range of 18-55 years and an average age of 32.96 years. All patients had 2 ml of venous blood drawn on an empty stomach early in the morning before admission for treatment, and placed in an ethylene diamine tetraacetic acid (EDTA) potassium anticoagulation tube. Fresh peripheral blood samples were generated and sent for examination immediately. Flow cytometry was used to detect the CD4 + , CD25 + , CD127 + cells and low Tregs ratio in peripheral blood of keloid patients ( n=50) and normal healthy people ( n=25); the fluorescence intensity was analyzed, the light scattering data were saved, and Cell Quest Plot was used on the computer after the test. The point diagram and the group square diagram were analyzed by SPSS 24.0 for statistical software analysis; peripheral blood Tregs ratio was expressed as the mean ± standard deviation ( ±s), and the mean comparison between the two groups was conducted by using independent sample t test; multiple groups One-way analysis of variance was used for the comparison of the averages, and the difference was statistically significant at P<0.05. The keloid questionnaire and clinical grading were utilized to deeply analyze the relationship between the Tregs ratio in peripheral blood of keloid patients and the severity of keloid. Results:Compared with the normal control group, the peripheral blood Tregs ratio of the keloid group was significantly reduced [(4.39±1.31)% vs. (6.64±1.83)%, P<0.001]; according to the Sawada score scale, keloids were classified as mild, moderate and severe degrees; the Tregs ratio in peripheral blood of the moderate keloid group was significantly lower than that of the mild keloid group [(4.43±1.23)% vs. (5.37±1.12)%, P<0.05], while in the severe keloid group it was also significantly lower than the moderate keloid group [(3.55±0.97)% vs. (4.43±1.23)%, P<0.05]. Conclusions:The Tregs ratio of peripheral blood in patients with keloids is significantly decreased, suggesting that Tregs cell is one of the biomarkers to reflect the severity of keloids.