Objective:To explore the application process, efficacy and safety of MR-guided radiotherapy based on MR-linac in esophageal cancer.Methods:The clinical data of patients with esophageal cancer treated with MR-linac at Shandong Cancer Hospital and Institute from September 2021 to July 2022 were retrospectively analyzed, to investigate the treatment process of esophageal cancer with MR-linac, and to analyze the efficacy and safety of patients. All patients received MR-guided radiotherapy, underwent CT and MR localization, target area delineation, and design of the Monaco treatment planning system plan. Adaptation-to-position adjustment was conducted during the pre-treatment evaluation. The median number of fractions was 25, the median single dose of planning target volume was 1.8 Gy, and the median total dose was 50.2 Gy. Median follow-up was 16 months.Results:Among the 12 patients in the whole group, there were 1 case of cervical esophageal cancer, 3 cases of upper thoracic esophageal cancer, 4 cases of middle thoracic esophageal cancer and 4 cases of lower thoracic esophageal cancer, including 3 cases of neoadjuvant radiotherapy and 9 cases of radical radiotherapy. All patients had a smooth treatment process. The median treatment time was 33 min, and the patients had good compliance. For patients with radical radiotherapy, one month after radiotherapy, the number of objective remission cases was 3, and the number of disease-control cases was 9; six months after radiotherapy, the number of objective remission cases was 3, and the number of disease-control cases was 6. All patients treated with neoadjuvant radiotherapy underwent surgery within 2 months, and one patient achieved pathological complete remission. The most common acute adverse reactions were radiation esophagitis (7 cases) and leukopenia in bone marrow suppression (8 cases), with late-stage adverse reactions being radiation pneumonia (1 case). The adverse reactions to radiotherapy were slight, and no grade 4 or above adverse reactions were observed.Conclusion:The clinical treatment process for esophageal cancer under MR-guided radiotherapy based on MR-linac is feasible, with good curative effects and mild adverse reactions.

In recent years, with the in-depth research on rosacea, dermatologists′ understanding of rosacea has gradually increased. However, misdiagnosis and overdiagnosis emerge as a tendency because some doctors roughly equate erythema with rosacea, neglecting the differential diagnosis with other similar skin problems. This article discusses clinical manifestations and diagnostic criteria of rosacea, elaborates on how to make a correct diagnosis, and lists key points in differential diagnosis between rosacea and other skin diseases, with a view to providing a reference for clinicians in the treatment of rosacea, and to reducing its misdiagnosis and overdiagnosis.

Objective:To investigate the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with rosacea, and to analyze the relationship between breath test results and the occurrence of rosacea.Methods:Patients with rosacea were enrolled from the outpatient department of Xiangya Hospital from March 2022 to June 2023. The methane-hydrogen breath test was used to detect intestinal levels of methane and hydrogen in all patients to investigate the prevalence of SIBO. The basic information, clinical symptoms and severity, quality of life scores, gastrointestinal symptoms, and past medical history of the patients were collected. Statistical analysis was carried out by using the chi-square test, nonparametric test and multivariate logistic regression models to investigate the relationship between SIBO and the occurrence of rosacea.Results:A total of 116 patients with rosacea completed the methane-hydrogen breath test. They were aged 18 to 56 years (median [ Q1, Q3]: 25 [22, 33] years), and included 7 males (6.0%) and 109 females (94.0%) ; there were 43 cases (37.1%) of erythematotelangiectatic rosacea, and 73 (62.9%) of papulopustular rosacea. As the breath test showed, 94 patients were diagnosed with SIBO (81.0%, 95% CI: 72.7% - 87.7%) based on the breath tests, 84 showed positive hydrogen breath test results (72.4%, 95% CI: 63.3% - 80.3%), and 47 had positive methane breath test results (40.5%, 95% CI: 31.5% - 50%). Among the 67 patients with moderate to severe erythema, 33 (49.3%) showed positive methane breath test results, and 14 of 49 (28.6%) patients with mild erythema showed positive methane breath test results, with a rate difference of 20.7% ( P = 0.025, 95% CI: 13.9% - 27.5%) ; there were no significant differences in the positive rates of SIBO and hydrogen breath test results between the patients with moderate to severe erythema and those with mild erythema (both P > 0.05). No significant differences were observed in the age, gender, clinical subtypes, severity of papulopustules, flushing and burning sensation, or rosacea quality of life index scores between the SIBO-positive and -negative groups, between hydrogen-positive and -negative groups, and between methane-positive and -negative groups (all P > 0.05). Multivariate logistic regression analysis showed that methane positivity on breath test was associated with the severity of erythema in rosacea ( OR = 2.495, 95% CI: 1.102 - 5.649, P < 0.05) . Conclusions:The prevalence of SIBO was relatively high in the patients with rosacea. However, only the positive rate of methane breath test differed between the rosacea patients and non-rosacea controls, and there was some correlation between methane positivity on breath test and increased severity of rosacea erythema.

AIM:To investigate the role and possible mechanisms of disulfiram(DSF)in a rat model of heart failure with preserved ejection fraction(HFpEF)induced by high-fat diet(HFD)and nitric oxide blocker Nω-nitro-L-argi-nine methyl ester(L-NAME).METHODS:The HFpEF rat model was constructed using HFD and L-NAME.Sprague-Dawley rats were randomly divided into 3 groups:control group(fed with a normal diet and water),HFpEF group(fed with HFD and drinking water containing 0.5 g/L L-NAME),and DSF+HFpEF group(treated with DSF in addition to HFD and L-NAME).After 5 weeks,cardiac function of the rats was examined using echocardiography and exercise test.Myo-cardial pathological changes were detected using hematoxylin-eosin and wheat germ agglutinin staining,the degree of car-diac fibrosis was assessed using Masson staining,and apoptosis levels were observed using TUNEL staining.Western blot was performed to detect the expression of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),cleaved caspase-1,gasdermin D N-terminal fragment(GSDMD-N)in the myocardium,and serum level of N-terminal pro-brain natriuretic peptide(NT-proBNP),and interleukin(IL)-1β and IL-18 in the myocardium were detected by ELISA.RESULTS:Compared with control group,the rats in HFpEF group showed increased body weight,systolic blood pres-sure,diastolic blood pressure,E/E′ ratio,left ventricular anterior wall thickness at diastole and serum NT-proBNP level(P<0.05),and decreased E/A ratio and absolute value of global longitudinal strain(GLS;P<0.05).In contrast,the rats in DSF+HFpEF group showed decreased body weight,E/E′ ratio,diastolic blood pressure and serum NT-proBNP level(P<0.05),and increased E/A ratio and absolute value of GLS(P<0.05),with no significant changes in systolic blood pressure,left ventricular posterior wall thickness at diastole and left ventricular ejection fraction(P>0.05).The rats in HFpEF group had increased myocardial fibrosis area,cardiomyocyte cross-sectional area,and apoptotic rate compared with control group(P<0.05),while these indexes were reduced in DSF+HFpEF group(P<0.05).The results of Western blot and ELISA showed that the levels of NLRP3,cleaved caspase-1,GSDMD-N,IL-1β and IL-18 were increased in the myocardium of rats in HFpEF group compared with control group(P<0.05),but decreased in DSF+HFpEF group com-pared with HFpEF group(P<0.05).CONCLUSION:Disulfiram improves cardiac function and attenuates myocardial remodeling in HFpEF rats.The mechanism may be related to the modulation of NLRP3/caspase-1/GSDMD signaling path-way and the reduction of myocardial inflammatory response.

Paroxysmal kinesigenic dyskinesia (PKD) is the most common subtype of paroxysmal movement disorders, characterized by the chorea and dystonia triggered by sudden changes in movement or posture. The condition can be effectively controlled by medications such as carbamazepine and oxcarbazepine. PKD is an autosomal dominant inherited disorder, with causative genes identified as PRRT2 and TMEM151A. Due to insufficient understanding of this condition among clinicians, it is frequently misdiagnosed as epilepsy or hysteria, leading to delay of treatment. The systematic overview about the etiology, pathogenesis, epidemiology, clinical manifestations, auxiliary investigations, diagnostic criteria, differential diagnosis, therapeutic approaches, and prognosis of PKD is provided in this article.

Studies have shown that rosacea is related to inflammatory factors, neurovascular function, micro-ecological environment and other factors. The Janus kinase (JAK) -signal transducer and activator of transcription (STAT) signaling pathway involves a variety of inflammatory cytokines, and plays an important role in cell proliferation, differentiation, apoptosis, angiogenesis and immune regulation. This review summarizes the JAK-STAT signaling pathway and explores its potential role in rosacea.

Objective:To analyze the willingness-to-pay (WTP) for the treatment of acute facial inflammatory dermatoses with red and yellow light from light-emitting diodes (LEDs), and to evaluate their cost-effectiveness.Methods:A questionnaire survey was conducted on outpatients with or without acute facial inflammatory dermatoses, which mainly manifested as erythema and swelling, in Department of Dermatology, Xiangya Hospital from August 2019 to June 2020. The WTP for the treatment of acute facial inflammatory dermatoses of varying severity with red and yellow light from LEDs were investigated, clinical data on the prevalence of facial skin diseases, previous medical visits and quality of life were collected, and a benefit-cost analysis was conducted. Logistic regression analysis was conducted to investigate factors influencing the patients′ WTP for the LED treatment.Results:The median WTP of the subjects was 200, 300 and 300 RMB yuan for 1-session treatment of three cases of acute facial inflammatory dermatoses of increasing severity assumed to require 1-, 3-, and 5-session LED treatments respectively, and the WTP for 1-session treatment of case 2 and case 3 was higher than the cost of 1-session LED treatment (217 RMB yuan). The subjects with high family incomes (≥ 100 000 RMB yuan/year) were significantly more willing to pay for the treatment than those with low family incomes (< 100 000 RMB yuan/year) (case 1: 40.46% vs. 27.50%, χ2 = 7.00, P = 0.008; case 2: 60.69% vs. 44.5%, χ2 = 9.75, P = 0.002; case 3: 51.20% vs. 48.8%, χ2 = 6.54, P = 0.011), and the subjects who never suffered from facial inflammatory dermatoses were significantly more willing to pay for the treatment than those who ever suffered (case 1: 35.49% vs. 28.82%, χ2 = 1.56, P = 0.212; case 2: 56.10% vs. 42.34%, χ2 = 5.92, P = 0.015; case 3: 68.32% vs. 56.75%, χ2 = 4.58, P = 0.032). No significant difference in the WTP was observed among patients with different facial dermatoses, different degrees of impairment on quality of life, or different treatment experience (all P>0.05) . Conclusion:The cost of red and yellow light from LEDs for the treatment of acute facial inflammatory dermatoses manifesting as erythema and swelling was highly acceptable in this population, and it was worthy of clinical promotion.

BACKGROUND: Juvenile amyotrophic lateral sclerosis (JALS) is an uncommon form of amyotrophic lateral sclerosis whose age at onset (AAO) is defined as prior to 25 years. FUS mutations are the most common cause of JALS. SPTLC1 was recently identified as a disease-causative gene for JALS, which has rarely been reported in Asian populations. Little is known regarding the difference in clinical features between JALS patients carrying FUS and SPTLC1 mutations. This study aimed to screen mutations in JALS patients and to compare the clinical features between JALS patients with FUS and SPTLC1 mutations. METHODS: Sixteen JALS patients were enrolled, including three newly recruited patients between July 2015 and August 2018 from the Second Affiliated Hospital, Zhejiang University School of Medicine. Mutations were screened by whole-exome sequencing. In addition, clinical features such as AAO, onset site and disease duration were extracted and compared between JALS patients carrying FUS and SPTLC1 mutations through a literature review. RESULTS: A novel and de novo SPTLC1 mutation (c.58G>A, p.A20T) was identified in a sporadic patient. Among 16 JALS patients, 7/16 carried FUS mutations and 5/16 carried respective SPTLC1 , SETX , NEFH , DCTN1 , and TARDBP mutations. Compared with FUS mutation patients, those with SPTLC1 mutations had an earlier AAO (7.9 ± 4.6 years vs. 18.1 ± 3.9 years, P  < 0.01), much longer disease duration (512.0 [416.7-607.3] months vs. 33.4 [21.6-45.1] months, P  < 0.01), and no onset of bulbar. CONCLUSION Our findings expand the genetic and phenotypic spectrum of JALS and help to better understand the genotype-phenotype correlation of JALS.
Humans ; Amyotrophic Lateral Sclerosis/genetics* ; DNA Helicases/genetics* ; Genetic Association Studies ; Multifunctional Enzymes/genetics* ; Mutation/genetics* ; RNA Helicases/genetics* ; RNA-Binding Protein FUS/genetics* ; Serine C-Palmitoyltransferase/genetics* ; Child, Preschool ; Child ; Adolescent ; Young Adult

For the detection and identification of abnormal nodular tissues on the body surface, a microwave sensor structure loaded with a spiral resonator is proposed in this paper, a sensor simulation model is established using HFSS software, the structural parameters are optimized, and the actual sensor is fabricated. The S21 parameters of the tissue were obtained when nodules appeared by simulation, and the characteristic relationship between the difference of S21 parameters with position was analyzed and tested experimentally. The results showed that when nodules were present in normal tissues, the curve of S21 parameter difference with position change had obvious inverted bimodal characteristics, and the extreme value of S21 parameter difference appeared when the sensor was directly above the nodules, which was easy to identify the position of nodules. It provides an objective detection tool for the identification of abnormal nodular tissues on the body surface.
Microwaves ; Recognition, Psychology ; Computer Simulation ; Software

OBJECTIVE: To observe the expression level of cytokines in patients with sepsis and its effect on prognosis. METHODS: The clinical data of sepsis patients admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022 were analyzed retrospectively, including gender, age, and acute physiology and chronic health evaluation II (APACHE II), blood routine, procalcitonin (PCT), C-reactive protein (CRP), and cytokines levels [interleukins (IL-2, IL-4, IL-6, IL-10, IL-17), tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ)] within 24 hours of admission to ICU. The 28-day prognosis of the patients was followed up. The patients were divided into survival group and death group according to the prognosis. The clinical data between the two groups of sepsis patients with different prognosis were compared. Binary Logistic regression analysis was used to analyze the independent risk factors affecting the prognosis of patients with sepsis, and the receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of each risk factor for the prognosis of patients with sepsis. RESULTS: (1) A total of 227 patients with sepsis were enrolled, including 168 patients in the survival group (survival rate 74.0%) and 59 patients in the death group (mortality 26.0%). There were no significant differences in age (years old: 55.97±2.13 vs. 54.67±1.11) and gender (male: 71.2% vs. 57.1%) between the death group and the survival group (both P > 0.05), indicating that the baseline data of the two groups were comparable. (2) The APACHE II (19.37±0.99 vs. 14.88±0.61, P < 0.001) and PCT (μg/L: 12.39±2.94 vs. 4.14±0.90, P < 0.001) in the death group were significantly higher than those in the survival group, while the platelet count [PLT (×10⁹/L): 144.75±12.50 vs. 215.99±11.26, P = 0.001] and thrombocytocrit [(0.14±0.01)% vs. (0.19±0.01)%, P = 0.001] were significantly lower than those in the survival group. (3) The level of IL-6 in the death group was significantly higher than that in the survival group (ng/L: 577.66±143.16 vs. 99.74±33.84, P < 0.001). There were no statistically significant differences in other cytokines, IL-2, IL-4, IL-10, TNF-α, IFN-γ and IL-17 between the death group and the survival group [IL-2 (ng/L): 2.44±0.38 vs. 2.63±0.27, P = 0.708; IL-4 (ng/L): 3.26±0.67 vs. 3.18±0.34, P = 0.913; IL-10 (ng/L): 33.22±5.13 vs. 39.43±2.85, P = 0.262; TNF-α (ng/L): 59.33±19.21 vs. 48.79±29.87, P = 0.839; IFN-γ (ng/L): 6.69±5.18 vs. 1.81±0.16, P = 0.100; IL-17 (ng/L): 2.05±0.29 vs. 2.58±0.33, P = 0.369]. (4) Binary Logistic regression analysis showed that APACHE II and IL-6 were independent risk factors affecting the prognosis of patients with sepsis [odds ratio (OR) and 95% confidence interval (95%CI) were 1.050 (1.008-1.093) and 1.001 (1.000-1.002), P values were 0.019 and 0.026, respectively]. (5) ROC curve analysis showed that APACHE II and IL-6 had certain predictive value for the prognosis of patients with sepsis, the area under the ROC curve (AUC) was 0.754 (95%CI was 0.681-0.827) and 0.592 (95%CI was 0.511-0.673), P values were < 0.001 and 0.035, respectively. When the optimal cut-off value of APACHE II was 16.50 score, the sensitivity was 72.6% and the specificity was 69.9%. When the optimal cut-off value of IL-6 was 27.87 ng/L, the sensitivity was 67.2% and the specificity was 52.8%. CONCLUSIONS APACHE II score and IL-6 level have certain predictive value for the prognosis of patients with sepsis, the higher APACHE II score and IL-6 level, the greater the probability of death in patients with sepsis.
Humans ; Male ; Interleukin-10 ; Interleukin-17 ; Cytokines ; Tumor Necrosis Factor-alpha ; Interleukin-6 ; Retrospective Studies ; Interleukin-2 ; Interleukin-4 ; ROC Curve ; Sepsis/diagnosis* ; Prognosis ; Procalcitonin ; Interferon-gamma ; Intensive Care Units