Objective To analyze the MTHFR C677T gene polymorphism and homocysteine in women in early pregnancy in Ordos region,to clarify the distribution characteristics of MTHFR C677T gene polymor-phism and the correlation between the two,and to provide genetic basis for scientific guidance on folic acid supplementation during pregnancy and prevention of birth defects.Methods A total of 602 Han women in early pregnancy who were registered and underwent early pregnancy examinations in the gynecology clinic of Ordos Central Hospital from September 2022 to September 2023 were selected as the research subjects.Blood samples were collected from all research objects.MTHFR C677T gene polymorphism was detected by using PCR chip hybridization,and homocysteine level was detected by biochemical enzyme circulation method.Sta-tistical analysis of MTHFR C677T locus genotype and allele frequency,as well as their correlation with homo-cysteine was conducted.Results The detection frequencies of MTHFR C677T gene polymorphism CC,CT,and TT types were 23.6%,47.5%,and 28.9%,respectively.The detection frequencies of alleles C and T were 47.3%and 52.7%,respectively.There were statistically significant differences compared to Han women in Shanghai,Wenzhou,Meishan,Nanning,and other regions(P<0.05),but there was no statistically significant difference compared to Han women in Xi'an(P>0.05).The serum homocysteine level of pregnant women with TT genotype was higher than that of pregnant women with CC and CT genotypes,while the serum ho-mocysteine level of pregnant women with CT genotype was higher than that of pregnant women with CC gen-otype(P<0.05).The CT and TT genotypes of MTHFR C677T were both risk factors for hyperhomocys-teinemia in women in early pregnancy in this region,the risk was 2.80 and 8.07 times higher than that of the CC genotype,respectively,and the differences were statistically significant(P<0.05).Conclusion The distri-bution of MTHFR C677T gene polymorphism Han women in early pregnancy in Ordos region has regional characteristics and is correlated with homocysteine level.Developing personalized folic acid supplementation plans based on different genotypes during pregnancy is of great significance for preventing birth defects.

Concurrent chemoradiotherapy (CCRT) refers to the simultaneous treatment of chemotherapy and radiotherapy, and the effect of radiotherapy is enhanced with low-dose chemotherapy, which can reduce tumor recurrence and metastasis and improve clinical prognosis of patients. At present, the main factors for the increase of radiosensitivity of concurrent chemotherapy is that concurrent chemotherapy prevents the repair of tumor cells, and chemotherapy and radiotherapy act on different cell cycles and have synergistic effects. However, even for patients with locally advanced cervical cancer (LACC) who have undergone CCRT, the 5-year survival rate is only 60%, which is still not ideal. In order to improve the efficacy, researchers have conducted a series of exploratory studies, which consist of the combination of targeted drugs and immunodrugs, and neoadjuvant regimens before CCRT, etc. Although targeted or immunologic drugs are effective treatment of LACC, in view of the lack of large-scale evidence-based medical evidence, multi-center prospective and randomized phase III clinical trials and high-level articles are needed to improve the level of evidence-based medicine. This consensus summarizes several key evidence-based medical studies published recently, especially the clinical research progress in targeted and immunological therapies, providing reference for domestic peers.

OBJECTIVE: To investigate the expression and localization of metabotropic glutamate receptors 7 and 8 (mGluR7/8) in rat superior cervical ganglion (SCG) and their changes in response to chronic intermittent hypoxia (CIH). METHODS: We detected the expressions of mGluR7 and mGluR8 in the SCG of 8-week-old male SD rats using immunohistochemistry and characterized their distribution with immunofluorescence staining. The expression of mGluR7 and mGluR8 in the cytoplasm and nucleus was detected using Western blotting. A 6-week CIH rat model was established by exposure to intermittent hypoxia (6% oxygen for 30 s followed by normoxia for 4 min) for 8 h daily, and the changes in systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured. The effect of CIH on expression levels of mGluR7 and mGluR8 in the SCG was analyzed using Western blotting. RESULTS: Positive expressions of mGluR7 and mGluR8 were detected in rat SCG. mGluR7 was distributed in the neurons and small fluorescent (SIF) cells with positive staining in both the cytoplasm and nuclei, but not expressed in satellite glial cells (SGCs), nerve fibers or blood vessels; mGluR8 was localized in the cytoplasm of neurons and SIF cells, but not expressed in SGCs, nerve fibers, or blood vessels. Western blotting of the nuclear and cytoplasmic fractions of rat SCG further confirmed that mGluR7 was expressed in both the cytoplasm and the nucleus, while mGluR8 exists only in the cytoplasm. Exposure to CIH significantly increased systolic blood pressure, diastolic blood pressure and mean arterial pressure of the rats (all P < 0.001) and augmented the protein expressions of mGluR7 and mGluR8 in the SCG (P < 0.05). CONCLUSION mGluR7 and mGluR8 are present in rat SCG but with different localization patterns. CIH increases blood pressure of rats and enhanced protein expressions of mGluR7 and mGluR8 in rat SCG.
Male ; Animals ; Rats ; Rats, Sprague-Dawley ; Superior Cervical Ganglion ; Receptors, Metabotropic Glutamate ; Hypoxia

Adjuvant radiotherapy has become an important part of the standard treatment for breast cancer. Compared with the traditional postoperative radiotherapy, neoadjuvant radiotherapy has the theoretical advantages of more accurate target delineation, optimization of radiation strategy for breast reconstruction, increase of breast conservation surgery with tumor down-staging and avoiding breast surgery by improving pathological complete response rate, which have been confirmed by recent clinical research. Prospective studies are still needed for the optimal target delineation, dose fractionation, radiation-surgery interval, and combination with systemic therapies, aiming to provide the optimal treatment option for patients with early breast cancer.

Objective:To observe the feasibility of magnetic resonance (MR)-guided stereotactic body radiotherapy (SBRT) for non-small cell lung cancer, and analyze the dosimetric differences in the presence or absence of magnetic field.Methods:Three patients with non-small cell lung cancer were prospectively treated with MR-guided linac (MR linac) for SBRT, and the dose was calculated with or without magnetic field models. The differences of dose distribution with or without magnetic field models were compared. At the same time, the target coverage, plan pass rate and treatment time were described, and the complexity of the conventional accelerator backup plan and the magnetic field model were compared.Results:The treatment time of 3 patients was (36.67±6.11) min, and the average time of online adaptive planning was (14.4±1.7) min, which was basically tolerated by patients. The treatment plan pass rate (3%/3 mm) was 98.9%, the Gamma pass rate (3%/3 mm) of the online plan during treatment was 98.5% and the target coverage was 99.1%, which met the clinical needs. The dose in the low dose area of the lung was slightly lower than that in the case without magnetic field, whereas the dose in ribs and skin was slightly higher than that in the plan without magnetic field. The number of machine unit (MU) for online adaptive plan was slightly higher than that of the reference plan, and the number of MU for the conventional accelerator standby treatment plan was significantly lower than that of the MR linac plan under the same target coverage. The follow-up results showed that there was no adverse reaction, and the short-term efficacy was partially relieved.Conclusions:In the case of considering the influence of magnetic field, the treatment plan meeting the clinical needs can be obtained. It is proven that SBRT radiotherapy for lung cancer guided by magnetic resonance accelerator is feasible, whereas the treatment time and process are complex.

Objective:To search and obtain the best evidence of aerobic exercise for patients with chronic heart failure (CHF) to provide a basis for clinically formulating scientific and standardized aerobic exercise programs for CHF patients.Methods:BMJ Best Practice, Joanna Briggs Institute (JBI) Evidence-Based Health Care Center Database, Guideline International Network (GIN) , UpToDate, National Guideline Clearinghouse (NGC) , National Institute for Health and Clinical Excellence (NICE) , Scottish Intercollegiate Guidelines Network (SIGN) , CINAHL, Embase, Cochrane Library, Chinese Guidelines Network, PubMed, China Biomedical Literature Database (CBM) , WHO and cardiology professional websites were searched to collect all evidence for aerobic exercise for CHF patients. The search time limit was from the establishment of the database to May 31, 2020.Results:A total of 14 articles were included, including 6 guidelines, 1 expert consensus and 7 systematic reviews. Finally, a total of 17 best evidence for 4 aspects including the necessity of aerobic exercise, preparation before aerobic exercise, 4 elements of aerobic exercise and the mode of aerobic exercise were summarized.Conclusions:Aerobic exercise is safe and effective for patients with heart failure with decreased ejection fraction. The setting of exercise intensity should be based on the results of a symptom-restricted cardiopulmonary exercise test. Exercise for more than 6 months is effective for CHF patients. Intermittent aerobic training assisted resistance exercise can improve peak oxygen uptake, cardiorespiratory fitness and muscle strength of patients, so as to improve cardiac function and quality of life, which should be regarded as an important way of exercise for patients with stable CHF.

Since the establishment of the Chinese Society of Therapeutic Radiation Oncology 33 years ago, radiation oncology has developed rapidly in China. Based on previous survey data, this paper summarizes and reviews the development of radiation oncology in China (excluding Hong Kong, Macao and Taiwan regions) from the perspectives of radiotherapy units, relevant professionals, equipment, technologies and subject development, and looks forward to the future direction, and proposes a new concept—" precision radiotherapy" .

Objective:To investigate the efficacy and adverse effects of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) in preventing neutropenia in patients undergoing sequential adjuvant radiotherapy after postoperative chemotherapy for breast cancer.Methods:A total of 43 female patients with breast cancer from January 2017 to January 2019 in Shandong Cancer Hospital and Institute were analyzed prospectively. Twenty-one patients in the experimental group were given 6 mg of PEG-rhG-CSF subcutaneously 1-3 days before radiotherapy. In the control group, 22 patients were enrolled without PEG-rhG-CSF utilization. The lowest absolute neutrophil count (ANC), the number of days of radiotherapy interruption due to neutropenia, the number of recombinant human granulocyte colony-stimulating factor (rhG-CSF) used during radiotherapy and the occurrence of drug-induced skeletal muscle pain in the two groups were statistically analyzed.Results:No neutropenia fever was observed in the two groups during radiotherapy. In the experimental group, there was no case of grade Ⅲ neutropenia; while in the control group, there were 3 cases of grade Ⅲ neutropenia. The median value of the lowest ANC in the experimental group was 1.56×10 9/L, higher than that in the control group (1.37×10 9/L), with a statistically significant difference ( Z=-2.261, P=0.023). The median number of rhG-CSF used in the experimental group was 1, which was smaller than 2 in the control group, and the difference was statistically significant ( Z=-2.498, P=0.012). The median numbers of days of radiotherapy interruption due to neutropenia were 0 and 3 in the experimental group and the control group, with a statistically significant difference ( Z=-3.117, P=0.001). One case (4.8%) of drug-induced skeletal muscle pain was found in the experimental group and 5 cases (22.7%) in the control group, with no statistically significant difference ( χ2=1.586, P=0.208). Conclusion:PEG-rhG-CSF can effectively prevent neutropenia caused by radiotherapy after postoperative chemotherapy for patients with breast cancer, and can reduce the interruption of radiotherapy and the use of rhG-CSF during radiotherapy, which is helpful to the smooth process of radiotherapy.

Objective To observe the long-term effect,adverse reaction and cosmetic outcome of early-stage breast cancer with hypofractionated whole-breast irradiation (HF-WBI) after breast-conserving surgery.Methods A total of 206 patients with stage 0-Ⅱ breast cancer after breast-conserving surgery were included in Shandong Cancer Hospital Affiliated to Shandong University from May 2014 to August 2017.According to radiotherapy fraction,patients were divided into HF-WBI group and conventional whole-breast irradiation (CF-WBI) group.In HF-WBI group,116 patients received whole-breast radiation to 42.56 Gy in 16 fractions followed by tumor bed boost of 9 Gy in 3 fractions or 10 Gy in 5 fractions.In CF-WBI group,90 patients received whole breast radiation to 50 Gy in 25 fractions followed by tumor bed boost of 10 Gy in 5 fractions.The 2-year local recurrence rate,2-year mortality rate,acute adverse reaction,late adverse reaction and cosmetic outcome of the two groups were analyzed.Results The 2-year local recurrence rates of HF-WBI group and CF-WBI group were 0.86％ (1/116) and 2.22％ (2/90) respectively,and there was no significant difference between the two groups (x2 =0.049,P =0.824).The 2-year mortality rates of the two groups were 0.86％ (1/116) and 0 (0/90) respectively,and there was no significant difference (P ＞ 0.999).There were 108 cases (93.1％) in HF-WBI group and 84 cases (93.3％) in CF-WBI group with grade 0-1 acute dermatitis,and 8 cases (6.9％) and 6 cases (6.7％) with grade 2-3 respectively,with no statistically significant difference (x2 =0.004,P =0.948).There were 97 cases (83.6％) in HF-WBI group and 79 cases (87.8％) in CF-WBI group with grade 0-1 bone marrow suppression,and 19 cases (16.4％)and 11 cases (12.2％) with grade 2-4 respectively,with no statistically significant difference (x2 =0.704,P =0.401).In the two groups,there were 1 case (0.9％) and 3 cases (3.3％) with grade 1-2 radiation pneumonitis,and 115 cases (99.1％) and 87 cases (96.7％) with no radiation pneumonitis respectively,and the difference was not statistically significant (x2 =1.626,P =0.202).There was 1 case (0.9％,1.1％) with grade 1 breast edema in each group,and 115 cases (99.1％) and 89 cases (98.9％) did not occur breast edema,with no statistically significant difference (x2 =0.033,P =0.857).In the late adverse reactions,there were 5 cases (4.3％) and 3 cases (3.3％) with skin pigmentation in HF-WBI group and CF-WBI group respectively.There were 2 cases (1.7％,2.2％) with grade 1 subcutaneous tissue fibrosis in each group,and there were 1 case (0.8％) and 2 cases (2.2％) with grade 1 pulmonary fibrosis respectively.The differences between the two groups were not statistically significant (x2 =0.000,P ＞ 0.999;x2 =0.000,P ＞ 0.999;x2 =0.049,P =0.824).The 6-month,1-year and 2-year cosmetic outcome good rates in HF-WBI and CF-WBI group were 96.5％ (111/115) and 93.3％ (84/90),92.1％ (105/114) and 90.0％ (81/90),91.4％ (53/58) and 87.2％ (41/47) respectively.The differences between the two groups were not statistically significant (x2 =0.526,P =0.468;x2 =0.277,P =0.599;x2 =0.476,P =0.490).The whole course of radiotherapy time in HF-WBI group was 25 days or 29 days,which was significantly shorter than the 40 days of CF-WBI group.Conclusion HF-WBI after breast-conserving surgery has the similar long-term effect,acute and late adverse reaction and cosmetic outcome compared with CF-WBI,and the treatment time is significantly shorter.It can be further promoted as the optimal adjuvant radiotherapy for early-stage breast cancer after breast-conserving surgery.

To explore the value of CTA combined augmented reality(AR) navigation in tongue re-construction with free anterolateral thigh perforator (ALTP) flaps. Methods From December, 2016 to December, 2018, 9 cases of tongue cancer patients were treated with lingual reconstruction with the free ALTP flap. The domi-nant perforator was selected according to CTA before operation. The origin, course, locations at the level passing through the fascia lata of the perforators and digital flaps were located and marked under the guidance of AR naviga-tion technology. The flaps area were 6 cm×8 cm-8 cm×12 cm, and the donor sites were closed directly. The effect of the AR navigation was explored intraoperatively.The function of reconstructed tongue and donor site were followed-up 3 to 6 months postoperatively. Results All navigation-positioned perforators were confirmed by AR preoperatively. Intraoperative exploration showed that the perforators were accurately located. All flaps survived, and no vascular cri-sis occurred. The donor sites healed primarily with linear scars. The tongue was plump, and the function of voice and swallowing were favorable. Conclusion CTA combined AR navigation has the advantages of accurate location, easy to use and low cost in tongue reconstruction with free ALTP flaps.It is a worthy method to be popularized.