Objective To track and evaluate the implementation of the Radiation Shielding Requirements in Room of Radiotherapy Installations—Part 1: General Principle (GBZ/T 201.1–2007) among relevant personnel in medical radiation institutions, and to provide a scientific basis for revising the standard. Methods According to the Guidelines for Health Standards Tracking Evaluation (WS/T 536–2017) and the implementation protocol of standard evaluation, an online survey was conducted among 212 relevant workers from 146 medical radiation institutions across 18 provinces in China. The data were aggregated and analyzed with the use of Microsoft Excel 2010. Results A total of 215 questionnaires were returned, of which 212 were valid. Among the valid respondents, 77.8% believe that this standard is universally applied; 96.2% believe that this standard can meet work needs; 63.7% have participated in relevant training on this standard; 74.1% use this standard once or more per year; and 10.8% believe that this standard needs to be revised. Conclusion Medial radiation workers have a high rate of awareness of the basic information and content of the standard, but the understanding and application of the standard content need to be improved. We recommend that relevant departments further strengthen the promotion of and training on the standard, revise some content based on actual situation, and improve workers’ ability to use the standard.

Although immunotherapy has made a breakthrough in the treatment of cancer,the emergence of drug resistance has limited be-nefits in most patients,and reversing immunotherapy resistance remains a hotly debated and unresolved issue.The tumor microenviron-ment(TME)comprises a large number of T lymphocytes.During the biological processes of proliferation,activation,and the effect of tumor-infiltrating lymphocytes(TILs),TILs face severe local metabolic stress,resulting in metabolic reprogramming to meet the markedly increased energy demand and biosynthesis requirements.This process of adaptive changes in the metabolic pattern is closely related to the pheno-type and function of TILs,affecting immunotherapy efficacy and mediating immunotherapy resistance.In recent years,with the study of TIL metabolism and the search for specific metabolic regulatory points,targeting the TIL metabolic pathway could restore the tumor-killing func-tion and reverse immunotherapy resistance.This review explores the relationship between the metabolic reprogramming of TILs and im-mune resistance,and provides a new strategy for reversing immune resistance.

Traditional antibody drug conjugates(ADC)combine monoclonal antibodies with cytotoxic drugs to accurately strike cancer cells,but there are still many shortcomings in stability,targeting,efficacy,and safety.Novel ADC,such as bi-specific,site-specific,dual-payload,and pro-drug type ADC,can be optimized by simultaneously binding 2 different antigens or epitopes,selecting more stable linkers,coupling with specific amino acid sites of antibodies,carrying different drug payloads,and adopting prodrug strategies,while retaining the characteristics of traditional ADC.Significantly improving the stability,targeting,efficacy and safety of drugs can better meet the needs of clinical treatment.Novel ADC will play a more important role in cancer treatment in the future.Discussing the progress of novel ADC in cancer treatment and analyzing their advantages and challenges can provide theoretical support for the development of anti-cancer strategies and provide directions for drug research and development.

Objective:To explore the diagnosis, surgical methods and therapeutic effect of primary duodenal malignant tumor.Methods:The clinical data of 116 patients with primary duodenal malignant tumor from January 2010 to December 2018 were retrospectively analyzed.Results:Among 116 patients, adenocarcinoma was in 74 cases, interstitial tumor was in 25 cases, carcinoid was in 9 cases, the others was in 8 cases. Before operation, duodenoscopy was performed in 107 cases, and CT examination was performed in 76 cases. There were 57 cases of pancreaticoduodenectomy, 15 cases of duodenal segmental resection, 13 cases of subtotal gastrectomy and duodenal bulbar resection, 13 cases of duodenal partial resection, and 18 cases of palliative short circuit operation. The total incidence of postoperative complication was 31.9% (37/116), including pancreatic fistula in 8 cases (grade B 5 cases, grade C 3 cases), biliary fistula in 6 cases, abdominal infection in 5 cases, pulmonary infection in 4 cases, intestinal fistula in 3 cases, delayed gastric emptying in 3 cases, and hemorrhage in 8 cases. Four cases (3.4%) died during the perioperative period. Single factor Cox regression analysis result showed that the postoperative survival time was related to the tumor differentiation degree, operation method, tumor infiltration degree and lymphatic metastasis ( P<0.05 or <0.01); multi-factor Cox regression analysis results showed that the operation method, tumor infiltration degree and lymphatic metastasis were the independent risk factors for the postoperative survival time of patients with primary duodenal malignant tumor ( P<0.05). The patients were followed up until June 2021, and 9 cases were lost to follow-up. Kaplan-Meier survival curve analysis result showed that the postoperative overall 1-,3- and 5-year survival rates were 82.11%, 57.56% and 33.11%, respectively. Conclusions:Adenocarcinoma is the main primary malignant tumor of duodenum. Duodenoscopy and CT are the main examination methods. Radical resection is the most effective treatment for primary duodenal malignant tumor, and pancreaticoduodenectomy is the first choice. Surgical method, tumor infiltration degree and lymphatic metastasis are the independent risk factors affecting the prognosis of patients.

Objective To improve the diagnosis and treatment of infective endocardits(IE)by exploring the causes,pathogenic microorganism,clinical characteristics and therapeutic results of patients with IE.Methods From January 2006 to January 2016,89 cases with IE in Ganzhou People's Hospital were collected,and the clinical charac-teristics were analyzed retrospectively.Results Among the IE patients,40.5%had congenital heart diseases,33.7%had rheumatic heart diseases,18.0% were post－PCI or operative endocarditis,and patients without basic cardiac diseases accounted for 7.9%.The most common clinical manifestations were fever (86.5%),followed by anemia (85.4%).The blood culture positive rate was 63.4%.Streptococci viridians were the most common causative organ-isms(44.2%),followed by coagulase －negative staphylococci(21.2%).Eighty－six patients received echocardio-graphy examination,vegetation was observed in 61cases (68.5%).The hospital mortality rate was 10.1%,mostly due to refractory congestive heart failure and sepsis.Conclusion Congenital heart disease showed an upward trend, rheumatic heart disease decreased significantly.Intermittent fever,anemia are the main clinical manifestations.Blood culture positive rate is not high,Streptococcus viridians is the most common causative organism.Echocardiography is the main basis for the diagnosis.

OBJECTIVE:To investigate the clinical characteristics and rules of allergic reaction caused by anti-copper treat-ment with Sodium dimercaptoproane sulfonate(DMPS)injection,and to provide reference for diagnosis,treatment and monitoring of drug-induced allergic reaction. METHODS:By using retrospective analysis,allergic reaction reports of DMPS injection were se-lected from our hospital during Jan. 2013-Dec. 2015 were analyzed statistically. RESULTS:A total of 131 cases of allergic reaction were reported. The average age of the patients was(23.26±9.63)years old,mainly concentrated on 10-39 years old(87.79%). Al-lergic reaction mainly occurred in the first and second courses of treatment,accounting for 71.76%. For systems-organs involved, skin and its appendages disorders had the highest proportion (85.90%),being mainly the lesion of limbs (27.45%) and body (22.22%) involved;followed by systemic damage (12.33%). Clinical manifestations of systemic impairment were mainly fever, with rash or itching at the same time frequently. 131 patients had good outcome after treatment. The symptoms of 115 patients (87.79%)disappeared in 7 d. Serious cases accounted for 25.19%. The proportion of drug allergy history,the rate of anti-copper treatment failure with allergy prevention or desensitization therapy,and symptom duration in patients with severe ADR were higher or longer than that in general ADR cases,the difference was statistically significant(P<0.05). CONCLUSIONS:The allergic reac-tion of DMPS injection increased the difficulty of anti-copper treatment. ADR monitoring should be strengthened in the process of using DMPS,specially for the history of allergies and the first,second treatment courses of patients.

OBJECTIVE:To systematically review the efficacy and safety of Xiaoke pill versus glibenclamide in the treatment of type 2 diabetes mellitus,and provide evidence-based reference for clinical treatment. METHODS:Retrieved from Medline, PubMed,EMBase,Cochrane Library,CBM,CJFD,Wanfang Database and VIP Database,randomized controlled trials (RCT) about the Xiaoke pill(test group)versus glibenclamide(control group)in the treatment of type 2 diabetes mellitus were enrolled. Meta-analysis was performed by using Rev Man 5.2 software after document selection,data extract and quality assessment by Co-chrane systematical evaluation. RESULTS:A total of 15 RCT were included,involving 3 319 patients. Results of Meta-analysis showed the hemoglobin A1c (HbA1c) level [MD=-0.39,95%CI(-0.75,-0.02),P=0.04],fasting plasma glucose (FPG) level [MD=-0.70,95%CI(-1.27,-0.12),P=0.02],2 h PG[MD=-0.87,95%CI(-1.55,-0.20),P=0.01],incidence of thirst with desire for drinks [RR=3.35,95%CI(1.92,5.85),P<0.001],incidence of tiredness and debilitation[RR=5.74,95%CI(3.52, 9.36),P<0.001] and incidence of hypoglycemia [RR=0.67,95%CI(0.49,0.91),P=0.01] in test group were significantly lower than control group,the differences were statistically significant. CONCLUSIONS:Xiaoke pill has better efficacy and safety than glibenclamide in the treatment of type 2 diabetes mellitus,can obviously improve the HbA1c,FPG,2 h PG tevel and TCM symp-toms.

Background and objective It has been proven that toll-like receptor 5 (TLR5) plaied an important role in the development of tumor. In our previous study, we found that the expression of TLR5 was remarkably higher in non-small cell lung cancer (NSCLC) tissues than that in normal tissues, but the activation of TLR5 signaling pathway in NSCLC was still unknown. Te aim of this study is to investigate the expression of TLR5 in diferent types of NSCLC cell lines, and analyze the activity of the signaling pathway afer stimulated by its specific exogenous ligand fiagellin. Methods Te TLR5 protein was detected by immunofiuorescence and Western blot in three kinds of NSCLC cell lines, and the TLR5 mRNA was detected by RT-PCR. Select the cell line of TLR5 highest expression as the research object, and select the suitable concentration of fiagel-lin. NF-κB luciferase activity was detected to validate the TLR5 activation pathway through inhibitory signaling pathways by 0 μg/mL, 0.01 μg/mL, 0.1 μg/mL, 1 μg/mL, 10 μg/mL TLR5 antibody. Te chosen cell line was transfected by TLR5 shRNA plasmid, and p-IKBα, IKBα, p-ERK1/2, ERK1/2 and p-JNK of untrasfected and transfected cells were detected in the activ-ity of TLR5 signaling pathway by Western blot at 0 min, 10 min, 30 min and 60 min, respectively. Results Te expression of TLR5 was the highest in the lung adenocarcinoma cell line SPC-A-1 by immunofiuorescence, mainly expressed on the cell membrane. NF-κB luciferase activity of SPC-A-1 cells was the highest, and the activity was increased in a dose-dependent man-ner. 0.1 μg/mL fiagellin could significantly increase the NF-κB luciferase activity (P<0.05), while its activity could be inhibited by the TLR5 antibody in a negative correlation. Treated by 0.1 μg/mL fiagellin, compared with that of 0 min group, the levels of p-IKBα, p-ERK1/2, p-JNK of SPC-A-1 cells increased significantly afer 10 min, reached the peak at 30 min, and declined at 60 min (P<0.05). Compared with that of 10 min and 60 min group, the levels of p-IKBα, p-ERK1/2, p-JNK significantly increased at 30 min (P<0.05). While the levels of IKBα, ERK1/2 at 0 min, 10 min, 30 min and 60 min had no significant changes (P>0.05). SPC-A-1 cells transfected TLR5-shRNA were also stimulated by fiagellin (0.1 μg/mL). At 0 min, 10 min, 30 min and 60 min, p-IKBα and p-JNK proteins could not be detected, and the levels of IKBα and ERK1/2 had no significant changes (P>0.05), but the levels of p-ERK1/2 significantly increased as time went on (P<0.05). Conclusion Exogenous ligand fiagellin can ac-tivate TLR5 protein in NSCLC cell lines and initiate downstream signaling pathways. It may be relative to the development of NSCLC.

Objective To establish an UPLC method for determination of Triptolide in serum and explore its pharmacokinetics in patients with rheumatoid arthritis after oral administration of tripterygium glycosides tablet. Methods Three patients with rheumatoid arthritis were enrolled. Using Estazolam as internal standard, serum was extracted with acetic ether, and determination was performed on column of Waters Acquity C18 (2.1 mm×100 mm, 1.7 μm) with mobile phase consisted of acetonitrile-0.1% glacial acetic acid (30∶70) at the flow rate of 0.2 mL/min. The column temperature was 30 ℃, and the detection wavelength was set at 220 nm. The serum concentration of Triptolide was processed by DAS 2.1.1 computer program. Results Triptolide was well-separated from internal standard, and the retention time were about 4.9 min and 8.9 min, respectively. Linear range of Triptolide was 13.13-840.00 ng/mL. RSD of intra-day and inter-day were lower than 15%and the recoveries were 88.25%-99.33%. Pharmacokinetic parameters were as follows:Cmax was (159.97±42.43) ng/mL, Tmax was (1.33±0.58) h, T1/2βwas (7.51±2.26) h, and AUC0-12 h was (1131.12±89.20) mg?h/L, respectively. Conclusion Pharmacokinetics of Triptolide conformed to two compartment model. Triptolide can be quickly absorbed, and exists differences among individuals.

Objective To assess the evaluation of SRT (Stereotactic radiotherapy ) and 3D-CRT (Three-dimensional conformal ra-diotherapy)on treatment of brain metastasis from lung cancer .Methods From June 2009 to June 2011 ,74 patients with multiple brain metastasis(brain metastasis ≤3 ,tumor mass ≤3 cm) from lung cancer were analyzed retrospectively ,37 patients received 3D-CRT alone were retrospectively compared with 37 patients who received SRT alone .the results was evaluated by median survival time(MS) ,local control(LC) and toxicity effect .Results The median survival time(MS) was 9 .3 ,which 8 .6 months after 3D-CRT ,and 10 .6 months after SRT .the local control rate was 73 .5% for 3D-CRT ,and 79 .6% for SRT after 3 months .there was no difference between two groups on toxicity effect from stastic .Conclusion The SRT was a efficacious methods for the treatment of brain metastasis from lung cancer ,which could improve the local control rate ,but there was no more toxiticy .