Objective:To evaluate the effect of tumor volume on the radiation dose and efficacy of locally advanced cervical cancer patients undergoing radical radiotherapy and chemotherapy.Methods:Clinical data of 126 patients who were diagnosed with cervical cancer (stage ⅡB-ⅣA) and underwent radical concurrent chemoradiotherapy in Guangxi Medical University Cancer Hospital from November 2019 to November 2022 were retrospectively analyzed. The cut-off values of tumor volume before (pre-TV) and after (post-TV) external radiotherapy and tumor volume reduction rate (TVRR) were calculated by Jamovi software. The effects of pre-TV, post-TV and TVRR on short-term efficacy, progression-free survival (PFS), brachytherapy (BT) mode , high-risk clinical target volume (HR-CTV) and organs at risk (OAR) dose were investigated by univariate and multivariate analyses.Results:Pre-TV≥67.03 cm 3 and post-TV≥14.88 cm 3 were poor prognostic factors for 6-month PFS and objective response rate (ORR) (both P<0.05), and post-TV was an independent prognostic factor. In the TVRR≥73.0% and <73.0% groups, no statistical differences were observed in the 6-month PFS and ORR. In the pre-TV≥67.03 cm 3 group, the cases number of intracavitary brachytherapy (ICBT) and intracavitary / interstitial brachytherapy (IC/IS-BT) was 36 (50.0%), while in the pre-TV<67.03 cm 3 group, the cases number of ICBT and IC/IS-BT was 41 (76%) and 13 (24%), respectively ( P=0.003). In the post-TV≥14.88 cm3 group, the cases number of ICBT and IC/IS-BT was 28 (47%) and 32 (53%), while 49 (72%) and 17 (26%) in the post-TV<14.88 cm3 group, respectively ( P=0.002). The dose of HR-CTV D 90% in the TVRR≥73.0% group was significantly higher than that in the TVRR<73.0% group ( P=0.014), but there was no significant difference in the dose of bladder D 2 cm3, rectal D 2 cm3 and small intestine D 2 cm3 (all P>0.05). The dose of HR-CTV D 90% in the post-TV<14.88 cm 3 group was significantly higher than that in post-TV≥14.88 cm 3 group ( P<0.001), and the dose of bladder D 2 cm3 in the post-TV≥14.88 cm 3 group was higher than that in the post-TV<14.88 cm 3 group ( P<0.05). There was no significant difference in the dose of rectal D 2 cm3 and small intestinal D 2 cm3 between two groups (both P>0.05). The number of concurrent chemotherapy (≥4 times vs.<4 times) had no statistical difference for 6-month PFS and TVRR. Conclusions:Pre-TV and post-TV are the influencing factors of short-term efficacy and BT mode selection for locally advanced cervical cancer. Post-TV is an independent prognostic factor and also indirectly affects the dose of HR-CTV D 90% and bladder D 2 cm3 Increasing the number of concurrent chemotherapy (≥4 times) does not improve TVRR and short-term efficacy.

Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

Objective:To evaluate the efficacy and safety of omalizumab in the treatment of chronic urticaria in children.Methods:A retrospective study was conducted. Patients with chronic urticaria were collected from the Department of Dermatology, Hunan Children′s Hospital from January to December 2021, and divided into a control group and a combination group according to different medication regimens. The patients in the combination group received subcutaneous injections of omalizumab (150 mg, once every 4 weeks) combined with conventional-dosage antihistamines, while the patients in the control group were only treated with double-dosage or multiple types of antihistamines. The course of treatment was 3 to 6 months. The clinical efficacy and adverse reactions were evaluated at 3, 6, and 12 months after the start of treatment, and the recurrence was evaluated at 3 and 6 months after the end of treatment.Results:A total of 46 children with chronic urticaria were collected. There were 23 children (13 males and 10 females) in the combination group, aged from 6 to 17 years and including 16 aged from 6 to 12 years and 7 aged from 13 to 17 years; according to the total serum IgE levels before treatment, the patients in the combination group were divided into an increased IgE subgroup (11 cases) and a normal IgE subgroup (12 cases). In the control group, there were 13 males and 10 females, aged from 6.33 to 16 years and including 15 aged from 6 to 12 years and 8 aged from 13 to 17 years. At 3, 6, and 12 months after the start of treatment, the response rates in the combination group were all 86.96% (20/23), which were all significantly higher than those in the control group (52.17% [12/23], 56.52% [13/23], 56.52% [13/23], P = 0.010, 0.022, 0.022, respectively). In the combination group, the response rates at 3, 6, and 12 months after the start of treatment were all 14/16 in the children aged 6 to 12 years and 6/7 in those aged 13 to 17 years, and there were no significant differences between the two age groups (all χ2 = 0.01, P = 0.907) ; in the control group, the response rates were 5/15, 6/15 and 5/15 respectively in the children aged 6 to 12 years, which were all significantly lower than those in the combination group ( P = 0.002, 0.006, 0.006, respectively). In the combination group, the response rates at 3, 6, and 12 months after the start of treatment were all 9/11 in the increased IgE subgroup and 11/12 in the normal IgE subgroup, and there were no significant differences between the two subgroups (all P = 0.484). During the treatment, no serious adverse reactions were observed in the combination group or control group, and mild somnolence only occurred in 2 children in the control group. At 3 months after the end of treatment, no recurrence was observed in 16 patients in the combination group, 2 out of 6 patients experienced recurrence in the control group, and the recurrence rate was lower in the combination group than in the control group ( P = 0.030) ; at 6 months after the end of treatment, no recurrence was observed in 16 patients in the combination group, 3 out of 6 patients experienced recurrence in the control group, and the recurrence rate was lower in the combination group than in the control group ( P = 0.022) . Conclusion:Omalizumab combined with conventional-dosage antihistamines could improve the clinical efficacy and reduce the recurrence rate in the treatment of chronic urticaria in children, with few adverse reactions.

Cardiac surgery associated-acute kidney injury (CSA-AKI) is a common postoperative complication which seriously affects prognosis of patients. In recent years, various intelligent warning systems for early detection of CSA-AKI have been developed in combination of biomarkers and machine learning, but its clinical application value remains to be clarified. This article provides a review on the progress of the application of intelligent warning systems for CSA-AKI.

Objective:To investigate the effect of early external diaphragm pacing on the diaphragm function and prognosis of patients with mechanical ventilation.Methods:A total of 47 patients receiving invasive mechanical ventilation in the Emergency Intensive Care Unit of Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University) from October 2019 to July 2021 were selected and randomly divided into the treatment group ( n=23) and control group ( n=24). The patients in the control group received routine clinical treatment. On this basis, the treatment group received external diaphragm pacing treatment every day from the third day of mechanical ventilation until weaning, and was followed up to 30 days after discharge. The diaphragm thickness, diaphragm excursion, diaphragm thickening fraction, mechanical ventilation time, number of weaning failures, length of hospital stay and death toll were compared between the two groups. Results:Compared with the control group, the diaphragm thickness [(0.21±0.05) cm vs. (0.16±0.05) cm], diaphragm excursion [(1.38±0.37) cm vs. (1.11±0.48) cm], and diaphragm thickening fraction [26% (19%, 32%) vs. 18.5% (10.25%, 20%)] in the treatment group increased significantly (all P<0.05). The mechanical ventilation time was shorter in the treatment group [10 (7, 15) d vs. 13 (10.25, 19) d], and the difference was statistically significant ( P<0.05). There were no significant differences in the number of weaning failures (7 vs. 9), length of hospital stay [22 (15 , 30) d vs.. 24 (17.25, 34.25) d] and deaths (8 vs. 8) (all P>0.05). Conclusions:Early application of external diaphragm pacing can improve the diaphragm function of patients with mechanical ventilation, delay the decline in diaphragm function, increase diaphragm excursion and diaphragm thickening fraction, and shorten the mechanical ventilation time.

Objective:To evaluate the feasibility of CT volume rendering technology in the assessment of the physeal bar in children.Methods:A retrospective analysis of the relevant CT data of 20 patients with physeal bar from January 2019 to December 2021, 13 boys and 7 girls, age 9.94±2.91 years. The etiology included 17 cases of trauma, 1 cases of tumor, and 2 cases of unknown. The affected sites included 9 cases of distal femur, 5 cases of proximal tibia, 3 cases of distal tibia, and 3 cases of distal radius. Evaluate using volume rendering technology and traditional surface reconstruction technology respectively and the index include the size and type of physeal bar.Results:All the children were successfully examined at one time, and none of them required sedation. The average exposure time was 3.81±0.83 s. During scanning, only low-dose radiation was performed on the affected joints, and routine radiation protection was performed. Using volume rendering technology to evaluate the proportion of the physeal bar, the results obtained by the three testers were 25.36%±15.36%, 24.75%±16.18%, 26.70%±17.72%, and the intraclass correlation coefficient value ( ICC) was 0.976, the three repeated measurements by one tester were 25.36%±15.36%, 25.41%±15.20%, 25.74%±16.00% ( ICC=0.990). Compared with the traditional curved planar reconstruction technical evaluation, the results obtained by the three testers were 28.36%±16.74%, 23.66%±19.87%, 35.25%±15.92% ( ICC=0.737), the three repeated measurement results by one tester were 28.36%±16.74%, 31.66%±13.06%, 30.89%±12.52% ( ICC=0.875). The volume rendering technology was better than the curved planar reconstruction technique. Paired t test was performed on the measurement results of three evaluators and the three repeated measurements of the same evaluator, and the differences were statistically significant ( P<0.05). The same results were acquired by using volume rendering technology to evaluate the type of phseal bar with three testers; but there were 18 cases had the same results by using curved planar reconstruction technology and 2 cases had differences, showing the volume rendering technology was more accurate. Conclusion:Low-dose CT scanning volume rendering technology is an effective method to evaluate the physeal bar in children. It can more intuitively and accurately evaluate the proportion and type of the bar while reducing the radiation exposure of children. The consistency with inter-group and intra-group is better than traditional curved planar reconstruction technique with good reproducibility and clinical significance.

Aristolochic acids (AAs) have long been considered as a potent carcinogen due to its nephrotoxicity. Aristolochic acid I (AAI) reacts with DNA to form covalent aristolactam (AL)-DNA adducts, leading to subsequent A to T transversion mutation, commonly referred as AA mutational signature. Previous research inferred that AAs were widely implicated in liver cancer throughout Asia. In this study, we explored whether AAs exposure was the main cause of liver cancer in the context of HBV infection in mainland China. Totally 1256 liver cancer samples were randomly retrieved from 3 medical centers and a refined bioanalytical method was used to detect AAI-DNA adducts. 5.10% of these samples could be identified as AAI positive exposure. Whole genome sequencing suggested 8.41% of 107 liver cancer patients exhibited the dominant AA mutational signature, indicating a relatively low overall AAI exposure rate. In animal models, long-term administration of AAI barely increased liver tumorigenesis in adult mice, opposite from its tumor-inducing role when subjected to infant mice. Furthermore, AAI induced dose-dependent accumulation of AA-DNA adduct in target organs in adult mice, with the most detected in kidney instead of liver. Taken together, our data indicate that AA exposure was not the major threat of liver cancer in adulthood.

Objective:To determine the median effective dose (ED 50) of 0.5% ropivacaine based on femoral nerve cross-sectional area for ultrasound-guided femoral nerve block. Methods:Patients of both sexes, aged 18-64 yr, of American Society of Anesthesiologists physical status I or Ⅱ, with body mass index of 20-30 kg/m 2, scheduled for elective open reduction and internal fixation for patella fracture or removal of patella fracture by internal fixation, were enrolled in this study.Ultrasonic localization of femoral nerve was performed for measurement of the femoral nerve cross-sectional area, and 0.5% ropivacaine was injected based on the area.ED 50 was determined by Dixon′s up-and-down sequential method.The initial dose was 0.22 ml/mm 2, and the difference between the two successive doses was 0.02 ml/mm 2.The effective block was defined as complete loss of pain sensation in the areas of anterior skin of knee joint, skin on the inner side of the calf and dorsal medial skin of the foot and the degree of motor block was in stages 1-3 assessed using Brunnstrom motor function within 30 min after nerve block.Nerve block was considered ineffective if pain occurred in any nerve distribution area mentioned above.The study was terminated if 7 effective and ineffective alternating waves occurred.ED 50 and 95% confidence interval (CI) were calculated using Probit analysis. Results:Twenty-seven patients were enrolled in the study with the femoral nerve cross-sectional area (75±5) mm 2.ED 50 (95%CI) of 0.5% ropivacaine for ultrasound-guided femoral nerve block was 0.106 (0.069-0.125) ml/mm 2. Conclusion:ED 50 of 0.5% ropivacaine based on femoral nerve cross-sectional area for ultrasound-guided femoral nerve block is 0.106 ml/mm 2.

Objective To evaluate the effect of propofol on high-mobility group box 1 protein (HMGB1)/Toll-like receptor 4 (TLR4) signaling pathway during hepatic ischemia-reperfusion (I/R) injury in rats.Methods Thirty-six clean-grade healthy male Sprague-Dawley rats,aged 3 months,weighing 250 -300 g,were divided into 3 groups (n=12 each) using a random number table method:sham operation group (group S),hepatic I/R group (group I/R) and propofol group (group P).Hepatic I/R injury was induced by occluding the portal vein and hepatic artery supplying the left and middle lobes of the liver for 1 h followed by 6-h reperfusion in anesthetized rats.Propofol was infused via the tail vein at a rate of 12 mg ·kg-1 · h-1 starting from 20 min before ischemia until 6 h of reperfusion in group P.The rats were sacrificed at 6 h of reperfusion,and the left lobe of the liver was removed for microscopic examination of the pathological changes which were scored and for determination of the expression of HMGB1,TLR4,tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-6) in liver tissues (by Western blot).Results Compared with group S,pathological scores of liver tissues were significantly increased,and the expression of HMGB1,TLR4,TNF-α and IL-6 was up-regulated in I/R and P groups (P＜0.05).Compared with group I/R,pathological scores of liver tissues were significantly decreased,and the expression of HMGB1,TLR4,TNF-α and IL-6 was down-regulated in group P (P＜ 0.05).Conclusion The mechanism by which propofol reduces liver I/R injury is associated with blocking HMGB-1/TLR4 signaling pathway and inhibiting inflammatory responses in rats.

OBJECTIVETo observe the clinical efficacy and action mechanism of acupuncture for ovulatory disorder infertility of ovarian induction period with clomiphene citrate (CC).

METHODSThrough retrospective analysis, 36 patients with ovulatory disorder infertility were divided into CC group (16 cases) and acupuoture group (20 cases) by method. The patients in the CC group were treated with oral administration of CC (50 mg) for 5 days from the 5th day of menstruation; based on the treatment of CC, patients in the acupuncture group were treated with acupuncture; the group A of acupoint was mainly consisted of acupoints of the conception vessel and the three meridians and front- acupoints in abdomen; the group B of acupoint was mainly consisted of acupoints of the governor vessel and back- acupoints. The two groups of the acupoints were selected alternately, combined with the -guan points (Taichong (LR 3)、Hegu (LI 4)) and five- points. The needles were inserted with flying needling method, and the needles were retained for 30 min per treatment; acupuncture was given once every other day. All the patients were treated for 2 months, and treatment stopped if pregnancy occurred. The pregnancy rate, cycle ovulation rate, maximum diameter of follicle, endometrial thickness and adverse effects were compared between the two groups.

RESULTSThe pregnancy rate of the acupuncture group was 75.0% (15/20), which was superior to 37.5% (6/16) in the CC group (<0.05). The cycle ovulation rates of two groups were 70.4% (19/27, >0.05). The maximum diameter of follicle and the endometrium thickness in the acupuncture group were superior to those in the CC group (both <0.05). The incidence of adverse effects in the acupuncture group was 0% (0/20), which was lower than 18.8% (3/16) in the CC group (<0.05).

CONCLUSION acupuncture combined with CC could improve the quality of follicle and the receptivity of endometrium in patients with ovulatory disorder infertility, so as to improve the pregnancy rate, which could be used as a safe and effective means to cooperate with modern assisted reproductive technology.