Objective To investigate the efficacy of hypofractionated radiotherapy (HFRT) combined with programmed cell death protein-1/programmed cell death ligand-1 (PD-1/PD-L1) inhibitors in sequential with granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-2 (IL-2) for the treatment of advanced metastatic solid tumors. Methods A prospective single-center single-arm study was designed for patients failed standard treatments for advanced refractory solid tumors in the Department of Radiotherapy of Jiangyin Hospital affiliated to Nantong University, and eligible patients were given quadruple therapy: HFRT (5 to 8 Gy × 2 to 3 f) once every 21 days for at least 2 cycles; 200 μg GM-CSF from the 1st to 7th day of radiotherapy, and 2 million IU IL-2 from the 8thto 14th day. Within 1 week after the completion of HFRT, PD-1/PD-L1 inhibitors were used for treatment. The above treatment strategy was repeated. GM-CSF and IL-2 were treated for 6 cycles, followed by maintenance with PD-1/PD-L1 inhibitors until disease progression (PD) or intolerable toxicity occurred. Objective response rate (ORR) and treatment-related adverse events were analyzed. Results From January 9, 2021 to June 15, 2023, totally 40 patients were enrolled, with follow-up of 2.8 to 31.0 months and a median follow-up of 9.9 months, and 39 patients (97.5%) completed at least one time tumorsite evaluation within the non-radiotherapy target area. 97.5% of patients had cancers, 2.5% had soft tissue sarcomas, and 20.0% had received immune checkpoint inhibitors (ICIs) at baseline check. The ORR was 30.8%, and the disease control rate (DCR) was 71.8%; the ORR for non-small cell lung cancer (NSCLC) was 28.6%, and the DCR was 57.1%; the ORR for colorectal cancer was 14.3%, and the DCR was 71.4%; the ORR for gastric cancer was 16.7%, and the DCR was 66.7%; 28 patients (70.0%) had treatment-related adverse events (TRAE), 4 patients (10%) had TRAE≥level 3, and the most common types of TRAE were fatigue, fever and hypothyroidism. Conclusion The treatment of HFRT combined with immune checkpoint inhibitors in sequential with GM-CSF and IL-2 is well tolerated and toxicity accepted in patients with advanced metastatic solid tumors, which may provide a new method for salvage treatment of patients with advanced metastatic solid tumors.

Objective To investigate the risk factors for acute radiation esophagitis andpneumonitis after radiation therapy in esophageal cancer (EC) patients with diabetes or hypertension.Methods A total of 373 EC patients receiving three dimensional conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT) were included in this study.Among these patients,42 showed concurrent with diabetes and 99 with hypertension.Radiation esophagitis or pneumonitis in patients with or without diabetes,and with or without hypertension were monitored in the 1-year follow up,respectively.Results The prevalence of grade 1,2,3 and 4 radiation esophagitis in diabetes and non-diabetes patients was 40.5％,38.1％,14.3％,4.8％ and 66.2％,27.8％,2.7％,1.8％,respectively,while that of the grade 1,2 and 3 radiation pneumonitis in diabetes and non-diabetes patients was 31.0％,16.7％,9.5％ and 30.8％,15.7％,1.2％,respectively.The prevalence of grade 3 or above radiation esophagitis and pneumonitis in patients with diabetes and was significantly higher than those with non-diabetes (x2 =13.573,12.279,P ＜ 0.05).The prevalence of grade 1,2,3 and 4 radiation esophagitis in hypertension and non-hypertension patients was 49.5％,38.4％,8.1％,3.0％ and 68.2％,25.5％,2.6％,1.8％,respectively,while that of the grade 1,2 and 3 radiation pneumonitis in hypertension and non-hypertension patients were 30.3％,18.2％,5.1％ and 31.0％,15.0％,1.1％,respectively.The prevalence of grade 3 or above radiation esophagitis and pneumonitis in patients with hypertension was significantly higher than those with non-hypertension (x2 =5.695、5.422,P ＜ 0.05).Diabetes is an independent risk factor for grade 3 or above acute radiation esophagitis and pneumonitis.Conclusions Diabetes or hypertension might be risk factors for severe radiation esophagitis and pneumonitis in EC patients receiving radiation therapy.

Objective To explore more suitable calculation method of the insulin dosage in insulin hypoglycemia-growth hormone stimulation test(insulin tolerance test, ITT). Methods Fifty-six subjects suspected of growth hormone deficiency were divided into primary and secondary onset groups. All the patients took oral glucose tolerance test and ITT. Homeostasis model of assessment for insulin resistance index ( HOMA-IR) and insulin sensitivity index ( ISI), area under insulin curve ( AUCINS ) and the area under glucose curve ( AUCPG ) were calculated. The insulin dosages during ITT between two groups were compared and the main factors influencing the insulin dosage were analyzed. Results There was no difference in the insulin dosage during ITT between primary and secondary groups. The actual dosage of insulin in this cohort study revealed a significant difference from the initial insulin dosage recommended by the guideline. Multiple linear regression analysis found that AUCINS and body mass index were the independent factors affecting the insulin dosage. Then the optimized coefficient of ITT ( γ) were found. Conclusion The insulin dosage used in our study was inconsistent with the guidelines-recommended ones. In order to make ITT more efficient and safer, a more optimized calculation method to improve the successful rate of insulin-induced hypoglycemia in ITT is proposed.

Objective To evaluate the effect of bandage rollers compression on pocket hemostasis in patients after implantation of permanent pacemaker.Methods A total of 591 patients after implantation of permanent pacemaker were enrolled in this study and divided into trial group and control group.The wounds of 296 patients in trial group received compression by two bandage rollers,which were placed parallelly on the wound side by side,above the pocket of pacemaker,fixed by 3M adhesive tapes so that no bleeding of wound and no shifting of rollers.6 hours after the operation,the tapes and bandage rollers were released.The wounds of 295 patients in control group received compression by 1 000 g sand bag which were taken off 6 hours after the operation.The safety and effects of hemostasis in patients between the two groups were compared.Results The incidences of incision bleeding,pocket hematoma and pocket skin pressure injury were not significantly different between the two groups(P>0.05).The incidences of postoperative pain,urinary retention and insomnia were significantly different between the two groups(P<0.05).Conclusion The incidences of postoperative pain,urinary retention and insomnia are significantly reduced in patients who received bandage roller compression.

Objective We sought to establish the standard operation procedures in department of cardiology.Methods According to the method of constructing standard operation procedures,the standard operation procedures for the department of cardiology was constructed through induction and consulting literature materials.Results 16 standard operation procedures for the department of cardiology were developed,including 8 SOP of common diseases to rescue,2 SOP of common operation in perioperative period,4 SOP for common instruments,2 SOP for common drugs usage.Conclusions Construction of standard operation procedures in department of cardiology can provide the basis for clinical nursing work,it can also supply methodological reference to build the standard operation procedures in other departments.

Objective To explore the role of apoptosis-inducing factors (AIF) mediated non-apoptosis classic pathway involved in neuron apoptosis of rats with chronic fluorosis.Methods Sixty Sprague Dawley (SD) rats (body weight 100-120 g) were divided into two groups (30 rats in each group,half male and half female) by random number table according to body weight.Control group was fed with tap water with fluoride content ＜ 0.5 mg/L and fluorine group was fed with water with fluoride content of 50.0 mg/L.Both groups were fed with standard food with fluorine content ＜ 0.5 mg/kg.After 10 months,all the animals were sacrificed though heart perfusion using phosphate buffer,and brain tissue was taken.Immunohistochemical method was employed to detect the distribution of AIF in brain tissue.Western blotting was used to test the protein expression of AIF,cl-caspase-3 and cl-caspase-9.Flow cytometry was used to examine apoptosis rate.Results The AIF positive distribution and degree of staining in the neurons of hippocampal CA1,CA2 and CA3,as well as the parietal cortex (7.50 ± 2.17,9.00 ± 1.63,8.00 ±0.82,10.24 ± 1.80) in rats with chronic fluorosis were significantly higher than those of the control group (5.18 ±1.66,6.27 ± 1.42,6.36 ± 1.96,6.96 ± 2.62,t =2.76,4.09,2.45,5.77,all P ＜ 0.05).The AIF protein expression of neuronal mitochondria in the cerebral tissue of rats with chronic fluorosis [(89.46 ± 8.47)％] was significantly lower than that of the control group [(100.00 ± 7.12)％,t =3.16,P ＜ 0.01],while the AIF protein expression of the neuronal nucleus [(112.80 ± 7.10)％] was significantly higher than that of the control group [(100.00 ± 8.20)％,t =3.75,P ＜ 0.01];cl-caspase-3 and cl-caspase-9 protein expression in the neurons of hippocampus and cortex from the rats with chronic fluorosis [(132.14 ± 18.66)％,(107.31 ± 2.58)％,(121.33 ± 14.86)％,(112.97 ± 7.97)％]were significantly higher than those of the control group [(100.00 ± 11.99)％,(100.00 ± 3.74)％,(100.00 ± 16.87)％,(100.00 ± 8.04)％,t =3.55,3.94,2.32,2.81,P ＜ 0.01 or ＜ 0.05].As compared with those of the control group [(1.28 ± 0.59)％,(1.88 ± 0.25)％],the apoptosis rates in hippocampus and cortex of the rats with chronic fluorosis [(2.55 ± 0.58)％,(3.05 ± 0.65)％] were significantly increased (t =3.08,3.40,all P ＜ 0.05).Conclusion Both of AIF-mediated caspase-independent apoptosis and the classic caspase-dependent apoptosis pathways have participated in neuron apoptosis in rat induced by chronic fluorosis,which may be one of the mechanisms of brain damage of the disease.

Angiocardiography ; Anti-Infective Agents ; therapeutic use ; Aorta ; abnormalities ; surgery ; Bronchopneumonia ; diagnosis ; drug therapy ; Cardiac Surgical Procedures ; methods ; Ductus Arteriosus, Patent ; diagnosis ; surgery ; Female ; Heart Defects, Congenital ; diagnosis ; surgery ; Humans ; Infant ; Pulmonary Artery ; abnormalities ; surgery ; Tomography, Spiral Computed

Thyroid hormone levels were fourd to be changed significantly in 93 patients with heart failure. Their T3 and FT3 decreased, while rT3 increased. The severer heart failure, the more evident change in thyroid hormone. The results suggest that the change in thyroid hormones might be an index in reflecting the severity of heart failure.

Objective To observe the lung protection of Astragalus membranaceus against radiotherapy to intermediate-stage and terminal thoracic neoplasm, and its influence on TNF-α and ET expression.Methods The patients with intermediate-stage and terminal thoracic neoplasm under radiotherapy were divided into a treatment group and a control group.Patients in the treatment group took 10 ml of Asragalus membranaceus twice a day.for consecutive 6 months from the beginning of radio therapy.TNF-α and ET in the plasma were measured before and after the radiotherapy.The clinical symptom,iconographic changes and lung diffusion were observed from the 15th day of radiotherapy.Results The TNF-α and ET in plasma afterthe radiotherapy were(2.48±0.75)as/ml and(69.32±23.03)pg/ml for the treatment group,and(5.12±1.01)ns/ml and(97.87±37.83)pg/ml for the control group with the statistial difference(x2=7.49,6.57,P<0.001).The decrease of CO diffusion 5 and 10 months after the radiotherapy in the treatment group was statistically different compared with that in the control group(x2=3.98,3.78,P<0.05).There was a statistical difference of the incidence of acute radiation pneumonitis and pulmonary fibrosis between these two groups(P<0.05).Conclusions Astragalus membranaceus could inhibit the excess expression of TNF-α and ET in plasma and reduce the deterioration of diffusion after radiotherapy,so that it can be used for intervention of lung injuries from radiotherapy.

Objective: The purpose of this study was to determine the relationship between TCM pattern and Hp infection and apoptosis of stomach mucosa in chronic gastritis, to discover the substance of TCM Pattern of chronic gasuitis on genetic molecular level and to establish syndrome differentiation system of chronic superficial gastritis on molecular level Methods: Get gastric mucosa tissue by electronic gastroscope. Hp infection, expression of Fas and bel-2 of 41 cases of incoordination between the liver and stomach group (IBLS group) and 50 cases of Dampness-beat in spleen and stomach(DHSS group) of chronic superficial gastritis were investigated by immunohistocbemistry examination, with 10 healthy persons as control group. Muti-factor non-condition logistic regression analysis was adopted to analyze the data. Results: The positive rate of HP was of 22%, 52% and 10% respectively in the IBLS group, the DHSS group and the control group. The positive rate of HP in the DHSS group was significant higher than in the IBLS and control group, showing there is a significant correlation between DHSS patern and HP infection. The expression rate of bcl-2 antigen was 24.2%, 76.0% and 30.0% respectively in the IBLS, DHSS and control group. The expression rate of bcl-2 antigen in the DHSS group was significant higher than in and the IBLS and control group(P＜0.01), showing there was significant correlation between DHSS pattern and expression rate of bcl-2 antigen(P＜0.01). The expression rate of Fas antigen was 70.7% and 46% respectively in the IBLS and DHSS group, the expression rate of Fas antigen in the IBLS group was significant higher than in DHSS group(P＜0.01), showing there was a significant correlation between IBLS pattern and expression rate of Fas antigen(P＜0.01).Conclusion: The result suggested that there was a certain relationship between HP infection and TCM pattern, the positive rates of HP was higher in DHSS pattern compared with the IBLS group. There was a certain relationship between the expression of bcl-2 and Fas in DHSS pattern, IBLS pattern may probably promoted apoptosis in gastritis, whereas HP infection performed as a main role in apoptosis in DHSS pattern. Bcl-2, liP and Fas might contribute to syndrome differentiation of chronic gastritis.