At present,precise radiotherapy has been widely used through the development with many years,but the existing technique still is limited by the limitation of tolerance dose of normal tissues,which cannot achieve the optimal goal of treating tumor.Flash radiotherapy(Flash-RT)is one kind of radiotherapy technique that uses the beam with ultra-high dose rate(UHDR)to conduct irradiation,which can furthest treat tumors while significantly reduce radiation injury of normal tissues.But until now,the biological mechanism,key physical parameters and triggering mechanism of Flash-RT are still unclear,and its principle and clinical translational application are still in the stage of research.This review clarified the technological advance and clinical translational application of Flash-RT research through summarized the relevant research of Flash-RT.

Objective:To investigate the efficacy and safety of endoscopic submucosal tumor resection without labeling and submucosal injection (NMSI-ESE) in the treatment of gastric small gastrointestinal stromal tumors.Methods:A retrospective analysis was conducted on the clinical data of 49 patients diagnosed with gastric small gastrointestinal stromal tumors in the Department of Gastrointestinal Surgery at the Shulan (Hangzhou) Hospital from January 2019 to December 2023. Among them, 23 cases underwent NMSI-ESE and 26 cases underwent traditional endoscopic submucosal tumor resection (ESE). We compared the clinical and pathological characteristics, surgical time, tumor removal time, number of metal clips used, surgical costs, postoperative hospitalization time, and incidence of complications between two groups of patients.Results:Compared with the ESE group, the NMSI-ESE group had shorter surgical time [38.95(26.50, 53.25)min vs 47.30(38.50, 52.25)min, Z=-2.60, P=0.011], shorter tumor removal time [17.27(8.75, 24.50)min vs 27.08(18.75, 35.00)min, Z=-4.32, P<0.001], and lower surgical costs [3 308(3.190, 3 450)yuan vs 4 107(3 972, 4 232)yuan, Z=-20.95, P<0.001], fewer metal clips used [(3.86±0.91) vs (5.04±1.22), t=-4.00, P<0.001], and shorter postoperative hospitalization time [3.1(2.0, 4.0)d vs 3.5(3.0, 4.0)d, Z=-2.20, P=0.031], There was no statistically significant difference in R0 resection rate and postoperative complications (all P>0.05). During the follow-up period, both groups of patients had no tumor recurrence or metastasis. Conclusions:NMSI-ESE is safe and effective in treating small gastrointestinal stromal tumors, and can shorten surgical and hospitalization time, as well as reduce medical costs compared to traditional ESE.

Despite growing prevalence and incidence, the management of gout remains suboptimal. The intermittent nature of the gout makes the long-term urate-lowering therapy (ULT) particularly important for gout management. However, patients are reluctant to take medication day after day to manage incurable occasional gout flares, and suffer from possible long-term toxicity. Therefore, a safe and easy-to-operate drug delivery system with simple preparation for the long-term management of gout is very necessary. Here, a chitosan-containing sustained-release microneedle system co-loaded with colchicine and uricase liposomes were fabricated to achieve this goal. This microneedle system was confirmed to successfully deliver the drug to the skin and maintain a one-week drug retention. Furthermore, its powerful therapeutic potency to manage gout was investigated in both acute gouty and chronic gouty models. Besides, the drug co-delivery system could help avoid long-term daily oral colchicine, a drug with a narrow therapeutic index. This system also avoids mass injection of uricase by improving its stability, enhancing the clinical application value of uricase. In general, this two-drug system reduces the dosage of uricase and colchicine and improves the patient's compliance, which has a strong clinical translation.

The report described one case of vascular paralysis syndrome during kidney transplantation to provide references for clinical practice.After intraoperative opening of kidney artery and vein, the recipient developed vascular paralysis syndrome.However, the efficacy is not obvious after dosing of norepinephrine.After an intravenous infusion of methylene blue, the recipient has a successful removal of tracheal intubation and recovered well.

Objective:To evaluate the effect of esketamine on postoperative acute lung injury (ALI) in pediatric patients undergoing living donor liver transplantation.Methods:Sixty pediatric patients of either sex with biliary atresia, aged 0-36 months, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, with cardiac function grade I or Ⅱ, with Child-Pugh grade B or C, undergoing living donor liver transplantation, were divided into 2 groups ( n=30 each) using a computer-generated table of random numbers: control group (group C) and esketamine group (group S). Combined intravenous-inhalational anesthesia was performed with propofol and sevoflurane in both groups, and in addition esketamine was intravenously infused continuously after induction in group S. After anesthesia induction (T 0), at 60 min after start of surgery (T 1), at 10 min after anhepatic phase (T 2), at 60 min after portal vein opening (T 3), and immediately after abdominal closure (T 4), central venous blood samples were collected for determination of the serum concentrations of Clara cell secretory protein 16, surface active protein D, soluble receptor for advanced glycation end-products, high mobility group protein B1, interleukin-1beta and tumor necrosis factor-alpha (using enzyme-linked immunosorbent assay), concentrations of malondialdehyde (using TBA method), and activity of superoxide dismutase (using hydroxylamine method). The dynamic lung compliance was recorded from T 0 to T 4. Blood samples were taken from the radial artery at T 0 and 24 h after surgery (T 5) for blood gas analysis, and oxygenation index and respiratory index were calculated. Lung ultrasound scores were recorded at 24 h before surgery and T 5. The postoperative mechanical ventilation time and duration of intensive care unit stay were recorded. The occurrence of ALI within 7 days after liver transplantation was observed. Results:Compared with group C, the serum concentrations of Clara cell secretory protein 16, surface active protein D, soluble receptor for advanced glycation end products, high mobility group protein B1, interleukin-1beta, tumor necrosis factor-alpha and malondialdehyde were significantly decreased, and the activity of superoxide dismutase was increased at T 3, 4, the oxygenation index was increased and respiratory index was decreased at T 3-T 5, lung ultrasound C score and B score were decreased at T 5, the postoperative mechanical ventilation time and duration of intensive care unit stay were shortened, and the incidence of ALI was decreased in group S ( P<0.05). Conclusions:Esketamine can alleviate postoperative ALI in pediatric patients undergoing living donor liver transplantation.

Objective: To explore the value of plasma cell-free DNA (cfDNA) in the assessment of inflammatory bowel disease (IBD) activity. Methods: From July 2014 to June 2017, 145 IBD patients from the First Affiliated Hospital of Fujian Medical University were selected. The plasma content of cfDNA was detected by picogreen-based fluorescent quantitative method. At the same period, 37 healthy individuals were enrolled as control group. The correlation between cfDNA content and C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and IBD activity was analyzed. The diagnostic capability of cfDNA in IBD activity was assessed by the receiver operating characteristic (ROC) curve. T-test was performed for comparison between two independent samples, and Pearson correlation coefficient test was used for correlation analysis between two variants. Results: The content of plasma cfDNA of patients with Crohn′s disease (CD) and patients with ulcerative colitis (UC) were (29.17±2.07) μg/L and (26.86±1.97) μg/L, respectively; which were both higher than those of healthy control group (21.10±1.02) μg/L, and the differences were statistically significant (t=2.609 and 2.082, both P<0.05). Moreover, the content of cfDNA of patients with active CD or UC were (35.72±3.26) μg/L and (32.37±3.42) μg/L, respectively, which were both higher than those of patients with CD or UC in remission ((21.12±1.43) μg/L and (20.82±1.02) μg/L), and the differences were statistically significant (t=3.806 and 3.116, both P<0.01). The cfDNA content of CD patients was positively correlated with CRP, ESR and disease activity (r=0.555, 0.393 and 0.400, all P<0.01). The cfDNA content of UC patients was also positively correlated with CRP, ESR and disease activity (r=0.640, 0.421 and 0.360, all P<0.01). The diagnostic capability of the combination of CRP and ESR was the highest in CD diagnosis, with the area under curve (AUC) value being 0.841, and the sensitivity and specificity being 81.4% and 74.3%, respectively. The diagnostic capability of the combination of cfDNA, CRP and ESR was the highest in UC diagnosis, with the AUC value being 0.851, and the sensitivity and specificity being 74.3% and 96.9%, respectively. Conclusions Increased cfDNA levels in IBD patients are correlated with IBD activity. Detection of cfDNA is helpful in the identification of active IBD, and the combination of ESR and CRP can improve the diagnostic efficiency of UC.

Objective To enhance the clinical diagnosis efficiency and accuracy of diabetic retinopathy (DR) to facilitate its early finding and diagnosis.Methods Image segmentation method was used to process and analyze DR vessel.Clinical images by fundus fluorescein angiography (FFA) were used as the objects for the research on DR vessel segmentation and extraction.Results Image processing and analysis gained higher definition and accuracy in segmenting the normal retinal image and DR vessel when they were compared with the fundus image and FFA image.Conclusion The method proposed enhances the early diagnosis of DR by processing and analyzing the retinal vessel,and thus contributes to the increased living quality of the patient.

Objective To improve the clinical prognosis of patients by reviewing ten years epidemiology data of acute poisoning inpatients.Methods The epidemiology data of the acute poisoning inpatients from 2006-2015 were retrospectively analyzed.The indexes including age,gender,nationality,geographical distribution,substance of poison,seasons,diagnosis and fee-for-service were collected.Results There were 1 083 patients with acute poisoning in total,624 cases (57.6％) for gas poisoning,213 cases (19.7％) for pesticide poisoning,136 cases (12.6％) for drug poisoning,74 cases (6.8％) for food poisoning and 36 cases for others.The ration of male to female was 0.94:1.The age of 31 to 45 range accounted for the highest proportion.The incidence of poisoning in 2011-2015 was significantly higher than that in 2006-2010 (P ＜0.05).The geographical distribution was also significantly different (P ＜0.05),most of the cases were in Shihezi city,then were Manasi and Sawan counties.Among the 1 083 patients,59％ cases were cured,33.6％ cases were improved after treatment,and the mortality rate was 2.6％.Feefor-service was also significantly increased in the older patients or males,and substance of poisoning dependent.The highest treatment cost was carbon monoxide poisoning,then were pesticide,drugs and food.Conclusions The common causes of poisoning in Shihezi city were carbon monoxide,organophosphorus pesticide,botulism and drugs,more emergency medical service should prevent poisoning and treat these patients.

OBJECTIVETo investigate the plasma level of extracellular histones in patients with silicosis, and to explore the role of extracellular histones in the pathogenesis of pulmonary fibrosis in silicosis.

METHODSSixty-two patients with silicosis were enrolled as the silicosis group, consisting of 23 patients with stage I silicosis, 25 with stage II silicosis, and 14 with stage III silicosis; sixty workers who had a history of occupational exposure to silica dust for more than 2 years and had not been diagnosed with silicosis were enrolled as the silica dust exposure group; sixty-five healthy workers without a history of occupational exposure to dust were enrolled as healthy controls. Enzyme-linked immunosorbent assay was applied to measure the plasma levels of plasma extracellular histone (H4) and transforming growth factor-β(TGF-β).

RESULTSCompared with healthy controls [(0.82±0.67) μg/ml], the silica dust exposure group[(4.14±2.85) μg/ml] and silicosis group[(9.50±5.04) μg/ml] had significant increases in plasma level of H4 (P<0.01). The plasma level of H4 was significantly correlated with the stage of silicosis(r=0.8955, P=0.0388). The silicosis group had a significantly higher plasma level of TGF-β than the silica dust exposure group and healthy controls(P <0.05). In the patients with silicosis, the plasma level of H4 was significantly correlated with that of TGF-β(r=0.5375, P<0.01).

CONCLUSIONThe plasma level of extracellular histones increases significantly in the pathogenesis of silicosis, and extracellular histones may play an important role in the progression of fibrosis in silicosis.

Case-Control Studies ; Disease Progression ; Dust ; Histones ; blood ; Humans ; Occupational Exposure ; Silicon Dioxide ; Silicosis ; blood ; pathology ; Transforming Growth Factor beta ; blood

Objective To explore the relationship of MDR1 and its encoded product P-gp expressions with clinical efficacy of transcatheter arterial chemoembolization (TACE)in primary liver cancer and their clinical significance.Methods We selected 108 patients with primary liver cancer who came to our hospital between June 2010 and June 2013 as observation subjects.Meanwhile 50 healthy people in our hospital for liver biopsy were selected as controls.MDR1 mRNA level in observation group and control group was determined by real-time quantitative PCR.P-gp protein level was analyzed by immunohistochemistry.According to P-gp level,the 108 patients were divided into drug-resistance groups and non-resistance group;the relationship between P-gp expression level and clinical efficacy was analyzed.Results MDR1 mRNA level in liver tissues significantly enhanced in observation group compared with that in control group (P <0.05).In observation group 32 patients had the ratio of MDR1 mRNA level-normal level of more than 2 and 76 patients had the ratio of MDR1 mRNA level-normal level of less than 2. Immunohistochemistry revealed that MDR1 encoded product P-gp was brownish yellow, mainly expressed in the cell surface of liver cancer cells.There were 35 P-gp protein-negative patients (non-resistance group)and 73 positive patients (resistance group).Clinical efficacy was significantly higher in non-resistance group (74.28%)than in resistance group (43.28%)(P <0.05).The 1 year and 2-year cumulative survival rates were 54. 12% and 27.40% in resistance group and 77.14% and 42.86%% in non-resistance group.They were significantly higher in the latter group (P <0.05 ).Conclusion The overexpressed MDR1 encoded product P-gp in primary liver cancer is associated with multidrug resistance in tumor chemotherapy,suggesting that P-gp can be used as one of the guiding clinical markers of chemotherapy.