Objective To compare the dosimetric characteristics of thyroid between intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) in patients with left-sided breast cancer after modified radical mastectomy. Methods Thirty patients with left-sided breast cancer who underwent adjuvant radiotherapy after modified radical mastectomy at the Huangpu Branch of the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, from December 2021 to May 2023, were selected as the study subjects, and IMRT and VMAT were used with a target prescription dose of 50 Gy/25 times. The target dose parameters of the two plans, including the mean dose (D_mean) and the dose-volume limit for organs at risk (V_x, x represents dose), were compared. Results The conformity index of VMAT was higher than that of IMRT (P＜0.001). Compared with VMAT, IMRT plan significantly reduced the V₅、V₁₀、D_mean of heart, the V₅ of right lung and the D_mean of right breast, while it significantly increased the V₂₀ of left lung (P＜0.001). There was no statistically significant difference in V₅ and V₁₀ of the left thyroid between IMRT and VMAT. However, the V₂₀, V₃₀, V₄₀, and D_mean of left and whole thyroid, and the V₁₀ and D_mean of right thyroid were significantly lower in IMRT than those in VMAT (P＜0.001). Conclusions Both IMRT and VMAT plans can meet the clinical dosimetric requirements, among which IMRT has lower thyroid exposure dose and is more suitable for patients with high cardiac requirements.

With the development of patient-centered medical model,patient values and preferences have become a hot research topic.This paper starts from the concept of patients'values and preferences,analyzes the important importance of patients'values and preferences;Based on the published literature,the importance of patients'values and preferences in the development of acupuncture clinical guidelines,the positive role in doctor-patient co-decision,the value of patients'cognition and value promotion in acupuncture"Deqi"were sorted out,and the influencing factors of patients'values and preferences and acupuncture compliance were summarized.According to the influencing factors,the corresponding solutions were proposed to help patients establish correct values,and thus improve patients'acupuncture compliance.

Objective:To investigate the value of postoperative radiotherapy in patients with cT 1-2N 1M 0 breast cancer after neoadjuvant chemotherapy and modified radical mastectomy which postoperative pathology showed that the number of axillary lymph node metastases was 0-3. Methods:One hundred and twenty-eight patients diagnosed with cT 1-2N 1M 0 breast cancer admitted to our hospital from January 1, 2000 to December 31, 2014 were retrospectively reviewed. All patients underwent neoadjuvant chemotherapy and modified radical mastectomy. The number of postoperative axillary lymph node metastases was 0-3. According to whether there was postoperative radiotherapy or not, the whole group of patients was divided into radiotherapy group ( n=87) and non-radiotherapy group ( n=41). In the two groups after operation, there were 43 and 11 patients with 1-3 axillary lymph node metastases (ypN 1), while there were 44 and 30 patients without axillary lymph node metastases (ypN 0) respectively. The 5-year locoregional recurrence-free survival (LRFS) rate, disease-free survival (DFS) rate and overall survival (OS) rate were calculated by Kaplan-Meier method, and the differences were compared by log-rank test. Univariate analysis was performed to analyze the effects of clinical features and treatment on prognosis. Results:The 5-year LRFS rate, DFS rate and OS rate of 128 patients were 91.4%, 82.8% and 93.0% respectively. The 5-year LRFS rates of the patients in the radiotherapy group and the non-radiotherapy group were 94.3% and 85.4% respectively, and the difference was not statistically significant ( χ2=3.055, P=0.080). As well as the 5-year DFS rates were 89.7% and 68.3% respectively, and the difference was statistically significant ( χ2=9.312, P=0.005). The 5-year OS rates were 94.3% and 90.2% respectively, and the difference was not statistically significant ( χ2=0.810, P=0.368). In the subgroup analysis, the 5-year LRFS rates of the patients who had achieved ypN 1 in the radiotherapy group and the non-radiotherapy group were 93.0% and 72.7%, and the 5-year DFS rates were 88.4% and 63.6%, with statistically significant differences ( χ2=4.248, P=0.039; χ2=4.525, P=0.033). The 5-year OS rates were 90.7% and 81.8% respectively, and the difference was not statistically significant ( χ2=0.713, P=0.399). The 5-year LRFS rates of the patients who had achieved ypN 0 in the radiotherapy group and the non-radiotherapy group were 95.5% and 90.0% respectively, with no statistically significant difference ( χ2=0.872, P=0.350). The 5-year DFS rates were 90.9% and 70.0% respectively, with statistically significant difference ( χ2=5.439, P=0.019). The 5-year OS rates were 97.7% and 93.3% respectively, with no statistically significant difference ( χ2=0.876, P=0.349). The univariate analysis indicated that age ( χ2=11.709, P=0.001) and blood vessel invasion ( χ2=7.608, P=0.006) were significant influencing factors for 5-year LRFS rate. Postoperative radiotherapy ( χ2=9.312, P=0.002) was a prognostic factor for 5-year DFS rate. Age ( χ2=6.093, P=0.014) and hormone receptor status ( χ2=3.974, P=0.046) were prognostic factors for OS. Conclusion:For the cT 1-2N 1M 0 breast cancer patients with 1-3 positive axillary lymph nodes after neoadjuvant chemotherapy, postmastectomy radiotherapy has local control benefit, and it can improve DFS. However, the benefit of postoperative radiotherapy needs to be further investigated in patients with pathological negative axillary lymph nodes after neoadjuvant chemotherapy.

Objective To investigate the effects of metformin on the radiosensitivity of breast carcinoma cells with different estrogen receptors stasus (MCF-7 and MDA-MB-231) and to explore the underlying mechanisms.Methods Two cell lines,MCF-7 and MDA-MB-231 in logarithmic phase were divided into four groups:control group,drug group (mefformin),irradiation group and experimental group (irradiation plus metformin).MTT assay and the clonogenic assay were performed to evaluate the effects of metformin on the proliferation and survival of breast carcinoma cell lines,respectively.The change of cell cycle distribution and apoptosis rates were measured by propidium iodide (PI) and Hoechst 33342 staining analysis repectively.Western blot was used to detect the expression of p-AMPK and p-mTOR.Resutls Metformin could obviously inhibit the proliferation of the two breast carcinoma cell lines in a dose dependent manner.The cloning formation capacity was decreased in the group of metformin plus irradiation,which displayed the values of Dq,D0 and SF2 significantly lower than those of irradiation alone group (MCF-7:t =9.305,14.528,13.708,P ＜0.05;MDA-MB-231:t =19.560,16.893,36.048,P ＜0.05),and the sensitizing enhance rate (SER) of D0 were 1.29 and 1.21 for MCF-7 and MDA-MB-231 cell lines,respectively.Compared with irradiation alone,metformin plus irradiation obviously increased the proportion of cells in the G2/M phase in both cell lines (t =6.103,38.431,P ＜ 0.05).Metformin plus irradiation also enhanced radiation-induced apoptosis in both cell lines so that the apoptosis rates were higher than that in the metformin group or irradiation alone group (t =9.143,14.561,P ＜ 0.05).In MCF-7 cell lines,the expression of p-AMPK in the metformin combined with irradiation group was significantly higher than other treatment groups (t =35.194,8.647,10.316,P ＜ 0.05),but no significant changes of p-AMPK expression in MDA-MB-231 cell lines was observed (P ＞ 0.05).While inhibition of p-mTOR by metformin was observed in both cell lines (MCF-7:t =80.133,31.820,11.308,P＜0.05;MDA-MB-231:t=12.436,15.757,8.402,P＜0.05).Conclusions This study suggests that metformin possessed a strong radiosensitizing potential in both breast carcinoma cell lines of MCF-7 (ER positive) and MDA-MB-231 (ER negative).This radiosensitizing effect may result from the activation of AMPK or AMPK-independent pathway,inhibition of mTOR signaling pathway,and the enhancement of radiation-induced G2/M phase arrest and cell apoptosis after metformin treatment.

Objective To analyze the risk factors of cortical micro-infarcts (CMIs) in patients with acute ischemic stroke and to evaluate the diagnostic value of 3.0 Tesla (T) magnetic resonance imaging (MRI) using double inversion recovery (DIR) sequence and 3-dimensional fluid attenuated inversion recovery (3D-FLAIR) sequence in CMIs in vivo.Methods One hundred and ten consecutive patients with acute ischemic stroke within 7 d of onset were chosen from August 2014 to July 2015;these patients were classified into CMIs group and non-CMIs group by results of 3.0 conventional T MRI,DIR-MRI and 3D-FLAIR-MRI.Baseline characteristics and risk factors were analyzed to investigate the independent risk factors of CMIs.The presence of CMIs was evaluated based on conventional T MRI,DIR-MRI and 3D-FLAIR-MRI.Results Of the 110 enrolled patients with acute ischemic stroke,CMIs were presented in 23.6％ patients (26/110).The age of patients from the CMIs group was significantly older as compared with that of patients from the non-CMIs group (67.65±10.37 vs.58.52± 11.24 years old,P=0.009).Patients from the CMIs group had significantly higher percentages of age＞65 years,age of 76-80 years,hypertension,history of cerebral ischemia and intracranial atherosclerosis than patients from non-CMIs group (P＜0.05).Multivariate Logistic regression analysis indicated that age＞65 years (OR=1.982;95％CI:1.362-2.889,P=0.010) and hypertension (OR=1.326;95％CI:1.022-1.682,P=0.026) were the independent risk factors of CMIs.The prevalence of CMIs detected by conventional sequence (10.9％) was significantly lower than that detected by DIR sequence (23.6％) or 3D-FLAIR sequence (20.9％,P=0.013 and P=0.043).Conclusions Age＞65 years and hypertension are independent risk factors of CMIs.DIR and 3D-FLAIR sequences at 3.0 T MRI substantially improve the sensitivity of detection of CMIs as compared with conventional MRI sequence.

Objective To explore the correlation between TOP2A gene expression and TCM constitutional types of patients with triple-negative breast cancer.Methods The questionnaire for constitution of Chinese medicine was used to identify the TCM constitutional types of 71 patients with triple-negative breast cancer and TOP2A gene alterations were quantified by real-time PCR. 2-ΔΔCt was used to analyze the expressions of each group. SPSS17.0 was employed to analyze the correlation between TOP2A gene amplification and TCM constitutional types.Results Totally 71 patients were divided into general type (0 case), Qi deficiency type (18 cases), Yang deficiency type (10 cases), Yin deficiency type (12 cases), Qi stagnancy type (7 cases), blood stasis type (10 cases), phlegm wet calculus type (8 cases), damp-heat type (6 cases), and special type (0 case). All of them were biased constitutional types, of which Qi deficiency constitution (25.35%), Yin deficiency constitution (16.90%), blood stasis constitution (14.08%) took the majority. TOP2A gene amplification was negative correlated with each constitutional type (P<0.05).Conclusion Biased constitutional types were the main types of TCM constitutional type of patients with triple-negative breast cancer. The main three biased constitutional types of triple-negative breast cancer were Qi deficiency constitution, Yin deficiency constitution and blood stasis constitution. TOP2A gene expression in patients with triple-negative breast cancer was normal or less expressed, which predicted low chemotherapy sensitivity and poor prognosis.

OBJECTIVETo study the objective diagnostic mechanisms on Chinese medical (CM) syndrome patterns of rheumatoid arthritis (RA), and to research different titers of rheumatoid factor (RF)/citrullinated protein antibody (CCP) in CM syndrome patterns of RA.

METHODSTotally 230 early RA patients were assigned to five CM syndrome pattern groups, i.e., the dampness-heat blockage group (50 cases), the cold-dampness blockage group (50 cases), the Shen-qi deficiency-cold group (50 cases), the Gan-Shen yin deficiency group (40 cases), and the blood stasis blockage group (40 cases). Another 100 healthy subjects were recruited as the healthy control group. RF-IGM, RF-IGA, RF-IGG, and anti-CCP antibody were detected and compared.

RESULTSThe titers of RF-IGM, RF-IGA, RF-IGG, and anti-CCP antibody were higher in all groups than in the healthy control groups (P < 0.01). As for the 5 groups, RF-IGM, RF-IGA,RF-IGG, and anti-CCP antibody were higher in the RA active stage than in the nonactive stage. They were higher in the dampness-heat blockage group in the RA active stage than in the Shen-qi deficiency-cold group, the Gan-shen yin deficiency group, and the blood stasis blockage group.

CONCLUSIONTiters of RF-IGM, RF-IGA, RF-IGG, and anti-CCP antibody could be taken as judging indicators for differentiating objective lab indices of CM syndromes and assessing the active stage of RA.

Adult ; Aged ; Arthritis, Rheumatoid ; blood ; diagnosis ; immunology ; Autoantibodies ; blood ; Case-Control Studies ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Peptides, Cyclic ; immunology ; Rheumatoid Factor ; immunology

ObjectiveTo compare the significance of anti-cmDNA antibody in systemic lupus erythematosus (SLE) patients detected with IIF on human's B lymphoma cell line Raji and promyelocytic line HL60.The diagnostic value of anti-cmDNA antibody in SLE was also explored.MethodsThree hundred and six patients with SLE were included in this study.As control groups,we included 192 patients with other rheumatic diseases and 50 healthy controls.The testing method for anti-cmDNA antibody was set up.The assessment of the significance of anti-cmDNA antibody in SLE detected with IIF on cell line Raji and HL60 was carried out andthe diagnostic value of anti-cmDNA antibody in SLE was investigated.ANA and antidsDNA antibody were measured by IIF at the same time.Anti-Sm was measured by immuno-diffusion andWestern blotting.AnuA was tested by enzyme linked immunosorbent assay.The statistical methods used in this study including McNemar X2 test,Spearman related test and Logistic regression analysis.Results The fluorescence brightness of Raji cell line was stronger than HL60 cell line.There was no statistically significant difference in the sensitivity and specificity of anti-cmDNA antibody in SLE detected with IIF with Raji or HL60 cell lines (P＞0.05).The sensitivity of anti-cmDNA antibody detected with IIF on Raji cell line was higher than anti-dsDNA antibody and anti-Sm antibody(P＜0.01),while the specificity of anti-cmDNA antibody was similar to anti-dsDNA antibody (P＞0.05) and was lower than anti-Sin antibody (P＜0.01).The sensitivity of anti-cmDNA antibody was similar to AnuA(P＞0.05) and the specificity was lower than AnuA (P＜0.01).The sensitivity of ANA was higher than anti-cmDNA antibody (P＜0.01) and the specificity was much lower than anti-cmDNA antibody(P＜0.01).The sensitivities of anti-dsDNA antibody,anti-Sm antibody and AnuA were much higher when combined with anti-dsDNA antibody than any one antibody only (P＜0.05).Anti-cmDNA antibody was correlated with mucosa ulcer in SLE patients(OR=2.343,P=0.029).The ESR of SLE patients was also correlated with anti-cmDNA antibody(OR=l.031,P=0.012).Anti-cmDNA antibody was not correlated with SLEDAI (r=0.070,P=0.600).ConclusionRaji cell line is better than HL60 cell line in detecting anti-cmDNA antibody with IIF.Anti-cmDNA antibody has higher sensitivity and specificity in SLE.Combined detection of anti-cmDNA antibody and other autoantibodies can further improve the diagnostic accuracy of SLE.

Objective To compare the significance of DNA-associated autoantibodies to cell membrane(cmDNA)in systemic lupus erythematosus(SLE)detected with indirect immunofluorescence on human B lymphoma cell line Raji and pmmyelocytic line HL60.Methods Indirect immunofluorescence assay both on cell line Raji and HL60 was used to measure anti-cmDNA antibodies in sera of 306 SLE patients.192 patients with other rheumatic diseases and 50 healthy controls.Results Indirect immunofluorescence assay on cell line Raji was used to measure anti-cmDNA antibodies.72.5% SLE and 10.4% other rheumatic diseases were positive for anti-cmDNA,but negative in 50 blood donors(P<0.01).Indirect immunofluorescence assay on cell line HL60 was used to measure anti-cmDNA antibodies,76.1% SLE and 16.7% other rheumatic diseases were positive for anti-cmDNA,but negative in 50 blood donors(P<0.01).The sensitivity of anti-cmDNA were 72.5%and 76.1%,respectively.The specificity of anti-cmDNA was 91.7% and 86.8%,respectively.There was no significant difference in sensitivity and spocificity(P>0.05).The methods of culture,freeze and resuscitation on the two cells were similar.but cell line Raji was easier to resuscitate than cell line HL60.Observing with fluorescence microscope.we find that cmDNA was expressed on the both cells and the staining was stronger on cellline Raji than HL60.Conclusion Anti-cmDNA antibody has high positivity which is one of the most valuable marker in the diagnosis of SLE.We recommend to measure anti-cmDNA antibodies with indirect immunofluorescence assay on cell line Raji rather than HL60.