BackgroundSchizophrenia is a common severe mental disorder with complex pathogenesis. There are few studies on the correlation between kynurenine metabolites in peripheral serum and urine in schizophrenia. ObjectiveTo investigate the concentration of tryptophan-kynurenine metabolites and interleukin-6 （IL-6） in serum and urine in patients with schizophrenia， and their correlation with clinical symptoms， so as to explore potential biological characteristics related to schizophrenia. MethodsA total of 38 patients with schizophrenia who met the criteria of the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）， and were hospitalized or attended outpatient clinic at Hangzhou Seventh People's Hospital from December 2021 to December 2022 were included in the study. Additionally， 26 healthy individuals were concurrently recruited from the community of Hangzhou to serve as a control group. All participants were requested to complete the Positive and Negative Symptom Scale （PANSS）. The levels of tryptophan （TRP）， kynurenine （KYN）， kynurenic acid （KYNA）， quinolinic acid （QUIN）， picolinic acid （PIC）， xanthurenate and 5-hydroxytryptamine （5-HT） in both serum and urine were measured using ultra-high-performance liquid chromatography-triple quadrupole linear ion trap mass spectrometry. Serum and urine IL-6 were measured using enzyme-linked immunosorbent assay. Pearson correlation analysis was conducted to examine the correlation between serum and urinary KYN metabolites， as well as the correlation between metabolite levels and clinical symptoms in the patient group. ResultsPatients with schizophrenia had significantly higher level of IL-6 in serum （U=798.500， P<0.01） and lower level of PIC in urine （U=253.000， P=0.013） compared with the control group. Additionally， level of serum KYN was positively correlated with QUIN/KYNA ratio and QUIN/PIC ratio （r=0.562， 0.438， P<0.05） in patients with schizophrenia. 5-HT/KYN ratio in serum was positively correlated with PANSS total score and negative symptom subscale score （r=0.458， 0.455， P<0.01） in patients with schizophrenia. ConclusionSerum TRP-KYN pathway metabolite levels in patients with schizophrenia were associated with neurotoxic metabolite ratios in urine and the severity of negative symptoms. ［Funded by Zhejiang Medical and Health Science and Technology Program Exploratory （number， 2022KY990）］

Postzygotic mutations are acquired in normal tissues throughout an individual's lifetime and hold clues for identifying mutagenic factors.Here,we investigated postzygotic mutation spectra of healthy individuals using optimized ultra-deep exome sequencing of the time-series samples from the same volunteer as well as the samples from different individuals.In blood,sperm,and muscle cells,we resolved three common types of mutational signatures.Signatures A and B represent clock-like mutational processes,and the polymorphisms of epigenetic regulation genes influence the pro-portion of signature B in mutation profiles.Notably,signature C,characterized by C＞T transitions at GpCpN sites,tends to be a feature of diverse normal tissues.Mutations of this type are likely to occur early during embryonic development,supported by their relatively high allelic frequencies,presence in multiple tissues,and decrease in occurrence with age.Almost none of the public datasets for tumors feature this signature,except for 19.6％of samples of clear cell renal cell carcinoma with increased activation of the hypoxia-inducible factor 1(HIF-1)signaling pathway.Moreover,the accumulation of signature C in the mutation profile was accelerated in a human embryonic stem cell line with drug-induced activation of HIF-1α.Thus,embryonic hypoxia may explain this novel signature across multiple normal tissues.Our study suggests that hypoxic condition in an early stage of embryonic development is a crucial factor inducing C＞T transitions at GpCpN sites;and indi-viduals'genetic background may also influence their postzygotic mutation profiles.

Irreversible electroporation (IRE) is an emerging tissue ablation technique. Compared with thermal ablation technique such as radiofrequency, IRE can achieve focal ablation in a shorter time without heat sink effect while sparing the tissue scaffold. IRE has been demonstrated to be a feasible therapeutic modality for the liver, pancreatic, and prostatic cancer. In recent years, several studies regarding of catheter-directed IRE for digestive tract, bronchus, urinary tract, and myocardium have been performed, which preliminarily demonstrated the safety and efficacy of IRE for tissue ablation under endoscopic or interventional technique. This study summarized the research progress of catheter-directed IRE for tissue ablation. The critical technique and future direction of catheter-based IRE are prosp.
Catheter Ablation ; Catheters ; Electroporation ; Endoscopy ; Humans

Objective To investigate the efficacy of lateral decubitus intramedullary nailing for treatment of subtrochanteric fractures of the femur.Methods From January 2012 to December 2015,23 patients with simple femoral subtrochanteric fracture were treated at Department of Orthopedic Trauma,Changhai Hospital.They were 15 males and 8 females,aged from 19 to 77 years (average,48.3 years).According to the Seinsheimer classification,there were 6 cases of type ⅡB,8 cases of type ⅡC,6 cases of type Ⅲ A,and 3 cases of type ⅢB.Their injuries were caused by traffic accident in 10 cases,falling from a height in 5 cases,and sprain in 8 cases.All patients were treated by closed reduction and anterograde intrarnedullary nailing at lateral decubitus.Their operative time,bleeding volume,fluoroscopic frequency,fracture healing time,functional recovery and complications were recorded and analyzed.Results Their operative time ranged from 55 to 80 min,averaging 65.7 min;their bleeding volumes ranged from 240 to 420 mL,averaging 304.3 mL;their fluoroscopic frequency ranged from 30 to 60 times,averaging 42.7 times.This cohort was followed up for 12 to 28 months (average,17.9 months).Their fracture healing time ranged from 4 to 10 months,averaging 5.5 months.Nonunion occurred in one patient but was cured by secondary operation.The HSS evaluation at the final follow-ups showed 17 excellent cases and 6 good ones,yielding an excellent to good rate of 100％.All the wounds healed by the first intention.No infection,deep vein thrombosis or implant failure was observed.Conclusion As lateral decubitus intramedullary nailing can achieve satisfactory clinical efficacy for subtrochanteric fractures of the femur,the body position of lateral decubitus may be a good alternative.

The application of placebo acupuncture in randomized controlled trials in the past 10 years (2004-2014) in foreign countries was systematically reviewed to summarize the design of placebo acupuncture; according to category of diseases, advantages and disadvantages were analyzed to explore an ideal placebo acupuncture set. By retrieval in PubMed, EMBASE and OVID databases, the clinical study literature which met the inclusion criteria was searched, and the category of diseases, design of placebo acupuncture and clinical efficacy were analyzed. Totally 29 articles were included. The pain was the leading disease in category of diseases; the most commonly used application of placebo acupuncture design was telescopiform sliding blunt needle, accounting for 45. 16%; the treatment locations were non-acupoints mostly; in the needling depth, approximately 60. 00% selected non-penetrating needling and 26. 67% selected superficial needling; 28 articles indicated that acupuncture and placebo acupuncture had clinical effects, accounting for 96. 55%; 37. 93% of articles indicated acupuncture was superior to placebo acupuncture and 37. 93% of articles indicated acupuncture was not superior to placebo acupuncture. It is concluded that the design of placebo acupuncture should consider multiple factors, including main symptoms, operability, security, blinding and specific effects, and the objective indices should be selected for outcome evaluation.
Acupuncture Therapy ; instrumentation ; methods ; standards ; Humans ; Internationality ; Needles ; Placebo Effect ; Randomized Controlled Trials as Topic ; standards

Objective To conduct the 7th investigation by Chinese Society of Radiation Oncology,Chinese Medical Association,and to further investigate the current situation of radiotherapy in mainland China,reasonably allocate personnel and equipment resources,and promote the development of radiotherapy in China.Methods From October 8,2015 to December 2015,the office for investigation of radiotherapy information was established,the list and contact information of radiotherapy units were provided by each province,and a special data submission system was used for a complete,rapid,and efficient investigation through the Internet.Results As of January 20,2016,there were 1 413 radiotherapy units in the mainland China with 52,496 employees in total,among which there were 15 839 radiotherapy physicians (4824 with senior professional titles),8 452 technical therapists (260 with senior professional titles),3 292 physicists (562 with senior professional titles),and 938 maintenance engineers (120 with senior professional titles).In the aspect of radiotherapy equipment,there were 1930 linear accelerators,96 Co-60 teletherapy units,173 X-knife units,212 γ-knife units,382 Ir-192 brachytherapy units,436 Co-60 brachytherapy units,1 051 X-ray simulators,1 353 CT simulators,642 MRI simulators,978 sets of multileaf collimators,1922 sets of treatment planning systems,and 974 sets of radiotherapy network systems.As for quality control devices,there were 1 792 dosimeters,2 143 ionization chambers,935 two-dimensional array dosimeters,540 threedimensional dosimetric verification systems,596 three-dimensional water tanks,844 anthropomorphic phantoms,and 1 168 water equivalent phantoms.In the aspect of therapeutic situation,there were 102,170 beds (including beds in departments of oncology in general hospitals),76612 episodes per day,and 919339 episodes per year.Conclusions The results of this investigation show significant increases in radiotherapy units,personnel,and equipment in recent years in mainland China.The distribution of radiotherapy units and equipment and the structure of radiotherapy personnel are becoming more reasonable,but there are still some problems.In some regions,current radiotherapy equipment cannot meet the medical needs,and there is a lack of professional technical personnel.

Objective To compare the short-term efficacy of high-intensity ultraviolet B (UVB) versus 308-nm excimer laser for the treatment of vitiligo.Methods Eighty patients with vitiligo were equally divided into two groups to be treated with high-intensity UVB twice a week or 308-nm excimer laser once a week for eight weeks.Repigmentation was evaluated at the end of the treatment.Results After eight weeks of treatment,repigmentation of different degrees was observed in 83.6％ and 86.1％,and marked repigmentation in 42.1％ and 50％,of the UVB-and excimer laser-treated lesions,respectively.The response rate was significantly lower in facial lesions receiving high-intensity UVB radiation than in those receiving excimer laser radiation (49.1％ vs.68.4％,x2 =4.32,P ＜ 0.05),but similar at the other body sites between the two treatment (all P ＞ 0.05).The cumulative dosage required for initial repigmentation was similar between high-intensity UVB and 308-nm excimer laser (t =0.89,P ＞ 0.05),while the treatment sessions and cumulative dosage required for marked or better repigmentation were significantly increased in UVB-compared with excimer laser-treated lesions (both P ＜ 0.01).In addition,both high-intensity UVB and 308-nm excimer laser were suitable for childhood and active vitiligo.Conclusions Both high-intensity UVB and 308-nm excimer laser are safe and effective in the treatment of vitiligo with rapid onset of action,and the latter appears to be superior to the former in efficacy.

Objective To investigate influence on dose distribution due to cavity and inhomogeneous structures using thermoluminescence dosimeters (TLD) and Chengdu phantoms.Methods A cavity 4 cm × 4 cm × 3 cm was made by a head and neck phantom and a lung phantom was cut into slices which were got a CT scanning and setup in a digital simulator.The TLD were pasted on edge and in the center of cavity structure and inhomogeneous structures.Treatment plans of different radiotherapy technologies were made generated and delivered on a linear accelerator.Then the TLD were read and analyzed.Results There were remarkable cavity effects of conventional single field,opposite fields and IMRT plans with 7 fields for head and neck phantom.There is similar effect in lung phantom.The more complexity the radiotherapy technology was the less cavity effect.Conclusions It is necessary to consider using more advanced radiotherapy technology or applying more fields to make treatment plans in order to decrease the cavity effect or similar effect when there are inhomogeneous structures.

ObjectiveTo study of the impact on dose distribution by electron width of energy spectrum and angular distribution using Monte Carlo simulation.MethodsThe simulated electron energy spectrum and angular distributions was as the input parameters and percentage depth dose (PDD) and offaxis curves were simulated by a modified PENELOPE code package. Results PDD and off-axis dose distribution curves are almost the same and are not sensitive to energy spectrum width and angular distribution with the exception of energy spectrum width of 2.5 MeV with obviously different curves.ConclusionsIn the situation of clinical treatment,spectrum and angular distributions can be ignored when their width are not very large.It is helpful to save about 9％ time by using monoenergy beams in treatment planning system development.

ObjectiveTo compare the calculation precision of the collapsed cone convolution (CCC) algorithm and pencil beam convolution (PBC) algorithm in TPS in heterogeneous tissue.Methods We made two virtual lung phantoms,one is single field phantom,In this case the photon beam incident into the phantom,the other is the two fields phantom and a cubic'tumor' was placed in the centre of the phantom.two opposite photon beams incident into the phantom.We calculated the dose of the'tumor' and the lung with the CCC and PBC algorithm.We compared the results in both case with if obtained from Monte Carlo (MC) method.ResultsIn the single field phantom,the photon beam incident from the high-density tissue to the low-density lung equivalent tissue,compared with the result of MC algorithm PBC algorithm overestimated the lung equivalent tissue dose (t =3.90,P =0.012) and the result of CCC algorithm is close to it ( t =2.25,P =0.087 ).In the two fields phantom,tumor boundary dose calculated by CCC algorithm and the MC algorithm are lower than that of the PBC algorithm (t =2.43,3.18,P =0.038,0.011 ),and the difference increase when the field size decrease, the beam energy increase and the density of the inhomogeneity decrease.ConclusionsWe had better use the CCC algorithm when calculating the dose of the tumor surrounded by low-density tissue or the tumor behind the low-density tissue,such as the lung cancer,esophageal cancer etc.