Radiation-induced lung injury （RILI）， one of the common complications caused by radiotherapy， encompasses two phases： an early phase known as radiation pneumonitis （RP） and a late phase called radiation fibrosis （RF）， threatening the life and life quality of patients， with poor prognosis. Accumulating evidence has shown that the occurrence of RILI is related to a variety of cytokines and signaling pathways. This paper summarized the research on the effects of Chinese medicine on RILI from the perspective of cytokines and signaling pathways. Cytokines include transforming growth factor-β₁ （TGF-β₁）， interleukins （ILs）， tumor necrosis factor-α （TNF-α）， platelet-derived growth factor （PDGF）， vascular endothelial growth factor （VEGF）， and high mobility group box-1 （HMGB1）. Related signaling pathways are phosphatidylinositol-3-kinase/protein kinase B（PI3K/Akt） signaling pathway， mitogen-activated protein kinase （MAPK） signaling pathway， Wnt/β-catenin signaling pathway， Notch1/Jagged1 signaling pathway， and nuclear factor-E₂-related factor2/antioxidant response element （Nrf2/ARE） signaling pathway. Cytokines may interfere with RILI progression by initiating various downstream signaling pathways， such as TGF-β₁/Smads signaling pathway， TGF-β₁/VEGF signaling pathway， TNF-α/nuclear factor-κB （NF-κB） signaling pathway， and HMGB1/Toll-like receptor 4 （TLR4） signaling pathway. In recent years， many scholars have attempted to delay RILI progression by down-regulating the expression of cytokines， antagonizing the effect of cytokines or regulating signaling pathways. It has been verified that many Chinese medicines， Chinese medicine monomers， and compound Chinese medicine prescriptions can inhibit the release of some cytokines or regulate some signaling pathways to reduce the incidence/severity of RILI， with satisfactory therapeutic effects， which have attracted the interest of scholars.

Objective: To conduct a systematic review and meta-analysis of studies evaluating the oncological and fertility outcomes of early-stage endometrial cancer (EC) treated with the levonorgestrel-releasing intrauterine system (LIUS)-based regimens. Methods: The Meta-analyses Of Observational Studies in Epidemiology statement for meta-analyses was followed. Searches were conducted on MEDLINE, Embase, PubMed, Preprints, and the Cochrane Central Register of Controlled Trials from January 1990 to August 4, 2022. The Joanna Briggs Institute Critical Appraisal Checklist was used for quality assessment. The primary endpoint was the complete response (CR) rate and the secondary endpoints were relapse, pregnancy, and live birth rate. Results: A total of 25 studies (821 women) were included. The CR rate of LIUS-based regimens was 63.4% (95% confidence interval [CI]=52.3%–73.2%), with 29.6% (95% CI=23.3%–36.8%) of cases experiencing recurrence during follow-up. In sensitivity analyses, patients younger than 45 years of age with a body mass index <30 kg/m2 who were treated with LIUS-based regimens achieved a high CR rate of 84.6% (95% CI=80.3%–88.1%) over a median follow-up of more than 24 months. Overall pregnancy and live birth rates were 37.9% (95% CI=24.1%–53.9%) and 39.3% (95% CI=24.0%–57.0%), respectively. No statistical differences were apparent in CR or relapse rates among the LIUS+GnRH agonist, LIUS+oral progesterone, or hysteroscopic resection followed by LIUS subgroups. Conclusion LIUS-based therapies are viable for the conservative management of early-stage endometrioid EC on CR and fertility outcome.

Objective:To compare the depth of cure, surface hardness and microleakage applied to primary teeth of three types of bulk-fill resins, so as to provide reference for clinical application.Methods:Composite resin Filtek TM Z350 XT (group A) and giomer Beautifil Ⅱ (group B) were used as controls, high-viscosity bulk-fill resin Filtek TM Bulk Fill (group C), sonic-activated bulk-fill resin SonicFill 2 (group D) and flowable bulk-fill resin SDR ? flow+(group E) were studied. The microstructure of each group was observed by scanning electron microscope (SEM). Specimens of each group were prepared (6 pieces per group), and the Vickers microhardness of the surface layer and different depths of each group were measured, and then the depths of cure were calculated. Twenty-five primary molars dentin were filled by resins of each group (5 teeth per group), sliced, then aged, slices of each group were developed by silver ion staining. SEM was used to observed the distribution of silver ions. Microleakage of each group were analyzed by Jonckheere-Terpstra rank sum test. Results:SEM showed that the filler particles in groups A and C were spherical and evenly distributed. The shape of the fillers in groups B, D and E were polygonal and unevenly distributed. The surface hardness of groups A, B, C, D and E were (84.97±6.30), (65.04±5.95), (57.80±1.18), (60.77±2.34), (33.32±1.83) MPa respectively. Group A had the highest hardness, while group E was the lowest, and the differences between the two groups and other groups was statistically significant ( P<0.05). There were no statistically significant differences among groups B, C, and D ( P>0.05). The curing depths of groups A, B, C, D and E were 2.6, 3.4, 5.8, 3.8 and 7.8 mm respectively. The largest microleakage was found in group E [2% (1/50) for grade 0, 22% (11/50) for grade 1, 30% (15/50) for grade 2, 24% (12/50) for grade 3, and 22% (11/50) for grade 4], which was statistically different from other groups ( P<0.05). No statistically significant differences were found among other 3 groups ( P>0.05). Conclusions:Both high-viscosity and sonic-activated bulk-fill resins have the greater depth of cure, the same hardness and microleakage as giomer, which might be an option for restoration in primary teeth.

Post-traumatic stress disorder(PTSD),as a mental disorder disease,can seriously damage the physical and mental health and social functioning of patients.Physical therapy is increasingly being used in research on the treatment of PTSD due to its ability to directly target specific brain regions and improve the core symptoms of PTSD.This review categorizes on physical therapy for PTSD into two categories:non-invasive physical therapy and invasive physical therapy.Non-invasive physical therapy methods included electroconvulsive therapy,transcranial direct current stimulation,transcranial magnetic stimulation,and the Flexyx neurotherapy system.Non-invasive physical therapy had the advantages of safety,convenience,and simple operation.However,their stimulation accuracy was limited.Invasive physical therapy methods included deep brain stimulation and stellate ganglion block.Invasive physical therapy had the advantages of precise stimulation,fewer adverse reactions.However,there were surgical risks,high operational difficulty,and high treatment costs.In addition,potential physical therapy methods included transcranial alternating current stimulation,magnetic seizure therapy,and vagus nerve stimulation,which were currently in the theoretical research stage.This study discussed the mechanism of action,therapeutic parameters,clinical efficacy,adverse effects and the latest forms of technology of the above physical therapy methods,so as to provide reference for the treatment of PTSD.

Objective:To evaluate the efficacy of parathyroid hormone 1-34 (PTH1-34) in the treat-ment of adjacent vertebral refracture after percutaneous kyphoplasty (PKP) for thoracolumbar osteoporotic com-pression fracture (OVCF).Methods:A retrospective study was made of the 43 OVCF patients who had been admitted to Department of Orthopedics, Shanxi Bethune Hospital for adjacent vertebral refracture after PKP from January 2014 to June 2018.Of them, 22 were treated by secondary PKP (group A), 9 by secondary PKP+PTH1-34 (group B), and 12 by merely PTH1-34 (group C).The vertebral heights of anterior border and middle-line and sagittal kyphosis cobb angle on X-ray films at 6 months after operation, the bone mineral den-sities of the left hip at admission, 6 and 12 months after operation, and the Oswestry Dysfunction Index (ODI) and Visual Analog Scale (VAS) scores at admission, 3, 6 and 12 months after operation were recorded and compared.Results:The 3 groups were compatible because there were no significant differences between them in the preoperative general data ( P>0.05).Recurrent OVCF was found in 3 patients in group A but not in group B or C.The vertebral heights and kyphosis cobb angle at 6 months after operation were significantly improved compared to the preoperative values in groups A and B ( P<0.05) but not in group C.The T values of bone mineral density at 6 and 12 months after operation in group B and at 12 months after operation in group C were significantly improved compared to their preoperative ones ( P<0.05) but not in group A.The post-operative ODI and VAS scores were significantly improved compared to the scores at admission in all the 3 groups ( P<0.05). Conclusions:In the treatment of adjacent vertebral refracture after PKP for elderly OVCF patients, PTH1-34 can significantly improve their bone mineral density, prevent collapse of the injured vertebra and reduce re-fracture of adjacent vertebral body.A combination of PTH1-34 and PKP is an effective treatment of adjacent vertebral refracture after PKP because it can restore the vertebral heights and reduce kyphosis deformity.

Objective: To evaluate the impact of long-term treatment with Entecavir(ETV)on renal function in elderly patients with chronic hepatitis B(CHB). Methods: Elderly patients with CHB receiving ETV(0.5 mg/d)antiviral therapy who were followed up for 234 weeks in Beijing Friendship Hospital were retrospective analyzed.The estimated glomerular filtration rate(eGFR)(CKD-EPI creatinine formula)was used to evaluate renal function changes at baseline and 52, 104, 156, 208 and 234 weeks after treatment. Results: A total of 40 included patients with CHB aged 60-81 years were enrolled, with baseline eGFR value(n=40) of (64.25±11.32)ml·min^-1·1.73 m^-2.The eGFR values at all time points after treatment were as following: (63.85±11.53)ml·min^-1·1.73 m^-2, (63.71±11.58)ml·min^-1·1.73 m^-2, (59.95±9.59)ml·min^-1·1.73 m^-2, (62.28±15.32)ml·min^-1·1.73 m^-2, (65.78±15.99)ml·min^-1·1.73 m^-2 at 52 weeks(40 cases), 104 weeks(40 cases), 156 weeks(38 cases), 208 weeks(36 cases)and 234 weeks(28 cases)after ETV treatment respectively.And the difference of eGFR values among all time points was not statistically significant(F=0.291, P=0.072). The results of the pairwise comparison showed that as compared with the baseline eGFR value, the eGFR values had no statistically significant difference at all time points after treatment(P>0.05). The baseline creatinine value in all 40 patients was(57.23±9.67)μmol/L.Creatinine values at 52 weeks(15 cases), 104 weeks(5 cases), 156 weeks(6 cases), 208 weeks(8 cases)and 234 weeks(6 cases)after ETV treatment, were(63.78±8.63)μmol/L, (67.86±11.21)μmol/L, (71.46±13.75)μmol/L, (68.22±8.99)μmol/L and(79.53±9.58)μmol/L respectively, with no significant difference(F=0.266, P=0.067). The results of the pairwise comparison showed that as compared with the baseline creatinine value, the creatinine values had no significant difference at all time points after ETV treatment(P>0.05). Conclusions ETV treatment has no effect on renal function in elderly patients with chronic hepatitis B.

Objective The multiple malformation of upper eyelid,including the excessive width of fold line,sunken and/or multiple folded upper eyelid are the common complications after blepharoplasty.The aim of this study was to investigate the clinical effect of orbital septum fat redistribution on correcting these deformities.Methods From September 2015 to September 2017,38 patients with multiple malformations of upper eyelid were treated.The incision of upper eyelid and the excessive skin was designed and resected.After completely relieving the scar adhesion zones,we set the lateral orbital septum fat free and transposed it to the inner side of orbital septum or superior border of tarsus with suturing fixation.Then we routinely completed the double eyelid operation.Results Thirty-eight patients with multiple malformations of upper eyelid were treated successfully.The patients were followed up for 6 months to one year,and the results were totally satisfactory.The operation was not performed again.Conclusions The orbital septum fat redistribution can successfully correct the multi ple malformation of upper eyelid.It should become a regular procedure in blepharoplasty.

Dual task walking (DTW) refers to the task of performing another attentional demand while walking naturally. It is quite common in our daily life, such as having a conversation while walking, or taking a call while crossing the street. People can simultaneously perform dual tasks normally. However, the performance of dual tasks will decline when the gait is impaired or cognitive dysfunction occurs.Neurodegenerative disease (NDD) is mainly characterized by motor and cognitive dysfunction, which seriously affects patients' ability of daily living activities. In recent years, studies on DTW in patients with NDD have found that decreased performance of DTW may be a feature of NDD patients, which may have important clinical value for early identification of NDD and predict disease progression. In the future, effective DTW training may improve the patients' ability of daily living activities, and it is important for the rehabilitation of NDD patients. This article mainly reviews the definition, common methods and mechanisms of DTW, as well as the clinical research findings and applications of DTW in patients with NDD, and provides theoretical basis for further clinical research.

Objective To investigate the effect of maternal separation (MS) on cognitive function in adult male rats through the expression of neuronal nitric oxide synthase (nNOS) in hippocampus, and to reveal the roles of early life stress (ELS) on neural development in rats. Methods Healthy SD pregnant rats (n=12) were randomly divided into maternal separation group (MS group) and control group (NMS group) (n=6 for each group). The newborn rats in the MS group were separated from the mother rats for 3 h every day from postnatal day 3 to 22 whereas no intervention was taken in the NMS group. At the age of 10 weeks, Morris water maze was used to test the learning and memory abilities of two groups of offspring male rats. Neuron immunofluorescence staining was used to examine the number and distribution of neurons in dentate gyrus (DG) of two groups of offspring male rats. Western Blot method was used to detect nNOS, eNOS, Bax/BCL2, Caspase-3 and P53 levels in the hippocampus of the two groups. Ki67/DCX immunofluorescence staining were used to examine the proliferation and differentiation of neurons in the DG area of the hippocampus. TUNEL staining was used to detect the neuronal degeneration and death in the DG area of the hippocampus. Results Behavioral tests showed that the escape latency of male rats in MS group was prolonged, the target quadrant residence time and the number of platform crossing decreased (P<0.05) compared with NMS group. Compared with NMS group, the number of normal and degenerated neurons in hippocampal DG area of MS group had no significant change (P＞0.05). However, the expression of nNOS and eNOS in hippocampus was decreased (P<0.05) and the expression of Bax/BCL2 was increased (P<0.05), but the expression of caspase-3 and P53 remained unchanged (P＞0.05). In addition, Neuronal proliferation and differentiation were decreased and apoptosis was increased in MS group (P<0.05). Conclusion Repeated MS reduces the expression levels of nNOS in the hippocampus, affects the neuronal function in the DG area, and has a long-term influence on the neurodevelopment, which results in cognitive deficits related to learning and memory abilities in adult rats.

Objective To identify the epidemiological changes in invasive fungal infection (IFI) in a neonatal intensive care unit (NICU) to provide information for prevention and treatment of IFI.Methods A total of 102 cases who were diagnosed with IFI among 42 187 neonates hospitalized in the NICU of Affiliated BaYi Children's Hospital,Chinese People's Liberation Army General Hospital from January 1,2009 to December 31,2014 were enrolled in this study.Since January 1,2012,the divisions of our NICU were more specific and intravenous fluconazole was administered as a routine preventive measure for high-risk infants.Clinical information of the IFI cases including general features,incidence,distribution of pathogens and drug (Amphotericin B,Fluconazole,Flucytosin,Itraconazole and Voriconazole) sensitivity were analyzed between former period (January 1,2009 to December 31,2011) and latter period (January 1,2012 to December 31,2014) by Chi-square test.Results The total incidence of IFI was 2.42‰ (102/42 187),and among the 102 IFI cases,73.5％ (75/102) were preterm infants and 75.5％ (77/102) were low birth weight infants.The incidence ofIFI in the latter period was lower than that in the former period [1.8‰ (48/26 046) vs 3.3‰ (54/16 141),x2=9.329,P＜0.01].The incidences of IFI in neonates with gestation age ＜28,≥ 28-＜32 and ≥ 32-＜37 weeks in latter period were decreased as compared with those in former period [10.6 ‰ (3/284) vs 76.9 ‰ (9/117),x2=12.569;6.1‰ (13/2 134) vs 21.9‰ (28/1 277),x2=16.868;1.4‰ (12/8 706) vs 1.9‰ (10/5 256),x2=7.165] (all P＜0.01).Altogether 103 pathogen strains were identified from 102 IFI cases as one Candida parapsilosis strain and one Laurent cryptococcus strain were both isolated from one patient.The most prevalent three pathogens were Candida albicans [51.5％ (53/103)],Candidaparapsilosis [24.3％ (25/103)] and Candida glabrata [8.7％ (9/103)].The isolated rates of Candida albicans and Candida glabrata strains in the latter period were higher than those in the former period [63.3％ (31/49) vs 40.7％ (22/54),x2=5.218;18.4％ (9/49) vs 0.0％ (0/54),x2=10.868],while the isolated rate of Candida parapsilosis strain was lower in the latter period than that in the former period [12.2％(6/49) vs 35.2％(19/54),x2=7.355] (all P＜0.05).All pathogen strains were sensitive strains except one Candida krusei strain which was isolated in the former period and was resistant to Fluconazole.Conclusions Premature infants born at lower gestational ages or with low birth weights are still at high-risk of IFI,but the incidence of IFI has declined in recent years.Routine administration of fluconazole in high-risk infants in NICU could prevente IFI without increasing drug resistance.Candida albicans is the predominant pathogen ofIFI.