Objective:To analyze the clinical characteristics of adult Chinese patients with syncope.Methods:This is a cross-sectional survey study. Patients with preliminary diagnosis of syncope in the Emergency Department, Geriatrics and Cardiology Outpatient Department, or Syncope Unit of 37 hospitals in 19 provinces, autonomous regions and the Hong Kong Special Administrative Region from June 2018 to March 2021 were included in this study. The clinical features of these patients with syncope were analyzed.Results:A total of 4 950 consecutive patients with syncope were included in this study. The age was (56.3±16.8)years, and 2 604 cases (52.6%) were male. The most common type of syncope was neurally mediated syncope (2 345 (47.4%)), followed by cardiac syncope (1 085 (21.9%)), orthostatic hypotensive syncope (311 (6.3%)), and unexplained syncope accounted for nearly one third (1 155 (23.3%)). Predisposing syncope was more common in patients under 65 years of age(2 066(72.4%) vs. 786(27.6%),χ 2=136.5, P<0.001). Presyncope was more common in patients with neurally mediated syncope (1 972(79.0%) vs.1 908(73.9%), χ 2=17.756, P<0.001). Premonitory symptoms were more common in women(1 837(80.0%) vs. 1 863(73.0%),χ 2=33.432, P<0.001). Presyncope syndrome was more common in patients under 65 years of age (2 482(77.8%) vs. 1 218(73.4%),χ 2=17.523, P=0.001). Cyanosis was more common in ≥65 years old patients (271(18.2%) vs. 369(12.7%), χ 2=23.235, P<0.001). Urinary incontinence was more common in old patients aged ≥65 years(252(15.2%) vs. 345(10.8%), χ 2=19.313, P<0.001). Family history was more common in patients with cardiogenic syncope compared with other types of syncope (264(24.3%) vs. 754(19.5%), χ 2=11.899, P=0.001). Hypertention(1 480(30.5%)), coronary heart disease(1 057(21.4%)), atrial flutter and atrial fibrillation(359(7.2%)), second degree atrioventricular block(236(4.8%)) were common complications of syncope. The proportion of patients with coronary heart disease was significantly higher in cardiac syncope than that of other types of syncope(417(38.4%) vs. 640(16.6%), χ 2=241.376, P<0.001). Other common complications included cerebrovascular diseases (551 (11.1%)) and diabetes mellitus (632(12.8%)). Conclusions:Neurally mediated syncope is the most common syncope in adult Chinese population. Patients with predisposing conditions and premonitory conditions are younger. Presyncope is more common in women. The proportion of family history and coronary heart disease is higher in patients with cardiogenic syncope.

Objective:To demonstrate the concept of planning target volume (PTV) is not suitable for intensity proton therapy (IMPT) in lung cancer, plan differences were compared based on the concept of PTV and Internal target volume (ITV), aiming to provide clinical reference.Methods:Six patients were retrospectively selected and approved by the local ethics committee. Each of the six patients received two IMPT plans based on a synchronous accelerator model, developed by SINAP team (Shanghai Institute of Applied Physics, China Academy Science University) and commercial treatment system: one with the PTV-based robust IMPT (PTV-IMPT) plan and the other with ITV-based robust IMPT (ITV-IMPT) plan. Three beams were set in all plans, and the final dose was calculated using Monte Carlo dose algorithm. The plan quality and robustness of PTV-IMPT and ITV-IMPT plans were evaluated quantitatively.Results:Compared to the PTV-IMPT plan, ITV-IMPT plan showed better target conformity index (conformability index: 0.58 vs.0.43), better homogeneity index (homogeneity index: 0.96 vs.0.92), lower V 5Gy in normal lung tissue (13.1% vs.13.5%) and maximum dose in spinal cord (8.9 Gy vs. 9.5 Gy) as well as plan monitor unit (MU: 338 vs. 401) . In addition, ITV-IMPT plan showed more robust in target coverage (0.003-0.032 vs. 0.02-0.28), and normal lung tissue was also found a bit robust in the ITV-IMPT plan ( 0.06-0.11, 0.07-0.13). Conclusions:Compared with the PTV-IMPT plan, ITV-IMPT plan has the advantages of high planning quality, well robustness and better tumor motion mitigation. Therefore, ITV concept is recommended to be applied in the IMPT plan for lung cancer.

Objective:The purpose of current study was to evaluate the interplay effects in intensity-modulated proton therapy (IMPT) for lung cancer and compare the results of different Iso-energy layer repainting techniques in the mitigation of interplay effects.Methods:Eight patients with lung cancer who underwent 4DCT were retrospectively selected. A robust CTV-based IMPT plan was generated for each based on commercial TPS, considering patient setup errors ±5 mm, range uncertainties ±3.5%, and CTV time structure motion in 4DCT image. Monte Carlo dose engines were used for all IMPT plans in the final dose calculation. The 4D static dose (4DSD) and 4D dynamic dose (4DDD) were calculated using a hybrid deformable algorithm and simulated proton delivery system for interplay effects. An index[ΔI(ROI, DVH)] was developed to quantitatively evaluate the interplay effects. We applied Iso-energy layer repainting techniques with different numbers of repainting (3, 4, 5, 6, 7) to the robust IMPT plans and evaluated the difference in the mitigation of interplay effects based on the ΔI(ROI, DVH) index.Results:Due to interplay effects, the mean values of target coverage, conformity and homogeneity index reduced by 13.7%, 12.7% and 24.6%, respectively. The mean values of lung V 5Gy and V 20Gy improved by 0.8%, 3.4% and 2.6%. Compared to the IMPT plans without layer repainting, Multiple iso-energy layers repainting techniques improved the mean values of CTV coverage by 4.5%, 3.8%, 3.8%, 3.6% and 5.7%, respectively. The average values of lung V 20Gy reduced by 1.5%, 1.8%, 1.7%, 1.6% and 1.9%, respectively. Conclusions:In the robust CTV-based IMPT plans, the interplay effects degraded the target dose distribution but were mitigated using iso-energy layer repainting techniques. We recommended to use the layer repainting technique according to the characteristics of the patient.

Objective To evaluate the effect of left atrial enlargement on atrial myocardial fibrosis degree and levels of the angiotensinⅡ (AngⅡ)/Rac GTPase activating protein 1 (Rac1)/signal transducersand activators of transcription 3 (STAT3) signaling pathways expressing in patients with persistent atrial fibrillation and rheumatic heart disease (RHD). Methods From March to December 2011, 30 patients with RHD who underwent prosthetic valve replacement in our hospital were enrolled, including 16 males and 14 females, aged 42-70 (56.9±6.8) years. Twenty RHD patients with persistent atrial fibrillation as a research group and ten RHD patients with sinus rhythm as a control group (group A) underwent transthoracic echocardiography and right atrial appendage (RAA) tissue samples were obtained from these patients during mitral/aortic valve replacement operation. The research group according to left atrial diameter (LAD) was divided into two groups, ten patients in each group: a group B with LAD of 50–65 mm and a group C with LAD of LAD>65 mm. For each sample, histological examination was performed by hematoxylin-eosin and Masson’s trichrome staining. Light-microscopic pictures of atrial tissues samples were stained and tissue fibrosis degree in each group was analyzed. AngⅡ concentration was measured by enzyme linked immunosorbent assay. Rac1 and STAT3 were measured by western blotting. Results LAD was significantly greater in AF patients with RHD than in the control group. Hematoxylin-eosin staining demonstrated highly organized arrangement of atrial muscles in the control group and significant derangement in both group B and group C with reduced cell density and increased cell size. Moreover, Masson’s trichrome staining showed that atrial myocytes were surrounded by large trunks of collagen fibers in both group B and group C, but not in the group A. There was a positive correlation between atrial tissue fibrosis and LAD. AngⅡ content was positively correlated with LAD. Similarly, Rac1 and STAT3 protein levels were found considerably higher in the group C and group B than in the group A with excellent correlation to LAD. Conclusion In patients with RHD complicated with persistent atrial fibrillation, the degree of atrial fibrosis and the expression level of AngⅡ/Rac1/STAT3 signaling pathways significantly increase with the left atrialenlargement.

Objective To assess the value of spectral CT imaging in distinguishing mass type colorectal adenocarcinoma from colorectal adenoma. Methods Forty patients underwent preoperative abdominal dual energy spectral CT scan were analyzed restrospectively, including 17 with colorectal adenomas and 23 with mass type colorectal adenocarcinomas proven by endoscopic and surgical pathology. All patients underwent plain and three-phase enhanced CT scanning. The conventional polychromatic CT value and its pre- and postcontrast CT values, monochromatic CT value of 40 to 100 keV, the slope of spectral curve and iodine(water) concentration were measured, and the maximum diameter of the lesion was recorded. The maximum diameters of the lesions and imaging parameter differences between the adenomas and adenocarcinomas in plain and three-phase enhanced scan were analyzed with independent sample t tests. The data of the parameters with significant differences were further analyzed by ROC curves. Results The maximum diameters of the adenomas and mass type adenocarcinomas were (1.97 ± 0.54), (2.32±0.53) cm respectively, and there was no statistically significant difference (t=-2.011, P=0.051). There was no statistically differences of the conventional polychromatic CT value and its pre-and postcontrast CT values between the two groups in 4 phases (P>0.05). However, in the arterial phase, the CT values of adenomas were significantly lower than those of adenocarcinomas at low (40, 50 keV) energy (P<0.05). The values did not differ significantly between these two groups at other phases (P>0.05). The slope of spectral curve and the iodine(water) concentration both showed significant differences in the arterial phase between the two groups (P<0.05), while they were not significantly different at other phases (P>0.05).The largest area under the ROC curve of the iodine(water) concentration in the arterial phase was 0.757 in differentiating adenomas and mass type adenocarcinomas, with sensitivity of 73.9%and specificity of 82.4%at the cut-off of 21.02 mg/cm3. Conclusion Spectral CT imaging is valuable in differentiating colorectal adenoma from mass type colorectal adenocarcinoma with the parameters of the arterial phase.

OBJECTIVE:To provide reference for implementing relevant policies and measures,and promote rational drug use. METHODS:The cognition(questionnaire)and application(prescription spot checks)about antibiotics and glucocorticoids by 191 rural doctors from 14 township hospitals and 18 health room in area A,B and C(representing the economically developed areas, moderately developed areas and undeveloped areas)were investigated,and the results were statistically analyzed. RESULTS:Total-ly 382 questionnaires were sent out(191 for antibiotics and 191 for glucocorticoids),and 382 were effectively received with effec-tive recovery of 100%;and 2 300 prescriptions were checked. Results of questionnaire showed,there were still some misunder-standings and blindness among the rural doctors'cognition and application about antibiotics and glucocorticoids,the usage of β-lac-tam was not fully grasped,part of the empirical use of antibiotics and drug treatment was still not entirely clear,more than 40%had no clear ideas about the classification and contraindications of hormones,and more than half of them didn't know the Glucocor-ticoids Clinical Practice Guidelines;results of prescription spot checks showed,there were regional differences about the proportion of antibiotics and glucocorticoids,area A had the highest proportion among 3 areas,accounting for 60.9% and 18.9%,respective-ly. And area C showed highest proportion about unreasonable prescriptions,accounting for 22.5%. CONCLUSIONS:The cognition and reasonable use of rural doctors for antibiotics and glucocorticoids still needs to be strengthened. It is suggested to take effective measures,formulate and implement the corresponding supervision system,strengthen antibiotics and glucocorticoids knowledge training for rural doctors and fully implement the the principles of rational drug use to improve the rational drug use.

BACKGROUND:In spectral CT imaging study, the selection of scanning parameters is considered by most researchers, but the effects of measuring position are often overlooked. Actual measurement found that different measurement location had significant impact on the result of the measurement. Through measurement and mathematical model of a large amount of data, we can correct the measurement results of different location. The results with real data alignment are higher. OBJECTIVE:To explore effects of different measuring positions on results in spectral CT imaging, and to optimize correction coefficients. METHODS:GE standard water phantom was applied to orderly obtain 5 combined scanning parameters with 552 groups of data. Size measurement method was divided into two measuring range:ROI1 and ROI2. We selected 10 points to measure CT value, including Center, North, South, West and East. The measurement data of ROI1 and ROI2 were classified and screened based on the same sequence. Mathematical modeling and probability statistics analysis were used to optimize correction coefficient, get calibration function and draw experimental simulation curve. RESULTS AND CONCLUSION:(1) Measuring methods of ROI1 were superior to the ROI2’s on water phantom in spectrum CT. (2) To different scanning sequences, the measuring results were different. To the same scanning sequences, the measurements for different positions on water phantom in spectrum CT had remarkable influence on the measuring results, which varied from points to points. (3) Through setting up mathematical modeling, using method of statistical analysis, we could get the correction function on different measuring positions. (4) Above results confirmed that compared with the theoretical model and the experimental data of spectral CT scanning parameters, the coefficients of position can be adjusted, which can optimize the measuring results.

Objective To assess the clinical significance of serum high sensitive C-reactive protein (hs-CRP) in patients undergone prostate biopsy.Methods A total of 273 consecutive patients were enrolled,aged 44-95 years (mean,69 years).All the patients underwent prostate biopsy.The pathological findings showed 96 cases with prostate cancer (PCa) and 177 cases with benign prostate hyperplasia (BPH).The difference of hs-CRP level between patients with PCa and those with BPH was analyzed.The positive prostate biopsy rate was compared between the patients with high hs-CRP level and those with normal hs-CRP level.Logistic regression was used to evaluate the effect of factors such as hs-CRP,tPSA,PSA density,prostate volume and age on prostate biopsy.Results The medians (interquartile range) of hs-CRP were 3.22 mg/L (1.22-9.84 mg/L) in patients with PCa and 1.24 mg/L (0.55-2.76 mg/L) in those with BPH,respectively,with significant difference(P＜0.05).The positive prostate biopsy rate in patients with high hs-CRP (＞ 3 mg/L)was 55％ (51/92),higher than that in those with normal hs-CRP (≤ 3 mg/L).The odds ratio of hs-CRP was larger than that of all other factors analyzed including tPSA,prostate volume and age according to the Logistic regression analysis.Conclusions Elevated serum hs-CRP level is associated with increased positive prostate biopsy.Serum hs-CRP acts as an independent factor increasing the positive prostate biopsy rate in patients undergone prostate biopsy.

Objective To discuss the clinical effect of restrict rehydration strategy on anastomotic healing of patients with colorectal cancer.Methods 483 cases of colorectal cancer ( from January 2008 to November 2009) were analyzed retrospectively,166 in fluid restriction group and 317 in tradition therapy group.Postoperative early rehabilitations and complications were studied and compared.Results The first time of passing flatus(3.9 d vs 4.4 d),first ambulation(2.9 d vs 3.3 d),oral intake(2.9 d vs 3.6 d),time with use of urinary catheter(4.6 d vs 5.5 d),and drains(2.2 d vs 3.1 d),and postoperative hospital stay ( 8.7 d vs 11.6 d) in fluid restriction group were significantly earlier or less than those in tradition therapy group ( P ＜ 0.01 ),while there were no significant differences in time with use of nasogastric tubes ( 1.1 d vs 1.2 d) between the 2 groups ( P ＞ 0.05 ).There was significant difference in the postoperative complications rate between the two groups ( P ＜ 0.05 ).Conclusions Restrictive fluid regimen could reduce the incidence of common complications for patients after colorectal surgery,and might have a certain promoter action to the anastomotic healing.

OBJECTIVE: To study the clinical and sequence character of the entire mitochondrial genome in five subjects with mitochondrial 12SrRNA T1095C mutation, and to analyze its relationship with the military noise-induced hearing loss (NIHL). METHOD: Three hundreds and four soldiers exposed to military noise were selected in Yunan and Beijing, including susceptible (experimental) and tolerance (control) groups. Mitochondrial 12SrRNA T1095C mutation were found in 5 subjects. Then the complete nucleotide sequence of five subjects were sequenced and its clinical character were analyzed. RESULT: m12SrRNA T1095C mutation were identified in 5 subjects of experimental group,and none were found in control group. There was significant difference between them (P < 0.05). All five soldiers had the history of military noise exposure and showed sensorineural deafness of different degrees. Sequence analysis of the complete mitochondrial genomes showed the distinct sets of mtDNA polymorphism besides T1095C mutation in five subjects. CONCLUSION The T1095C mutation in hearing loss subjects with various genetic background and history of military noise exposure, is involved in the pathogenesis of hearing impairment. It indicates that the T1095C mutation do relate well with military noise induced-hearing loss.
Adult ; Base Sequence ; DNA, Mitochondrial ; genetics ; Hearing Loss, Noise-Induced ; genetics ; Humans ; Male ; Military Personnel ; Mutation ; Young Adult