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Purpose This study was aimed to investigate long-term survivals and toxicities of early-stage nasopharyngeal carcinoma (NPC) in endemic area, evaluating the role of chemotherapy in stage II patients.Materials and Methods Totally 187 patients with newly diagnosed NPC and restaged American Joint Committee on Cancer/ International Union Against Cancer 8th T1-2N0-1M0 were retrospectively recruited. All received intensity-modulated radiotherapy (IMRT)±chemotherapy (CT) from 2001 to 2010.Results With 15.7-year median follow-up, 10-year locoregional recurrence-free survival, distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were 93.3%, 93.5%, 92.9% and 88.2%, respectively. Multivariable analyses showed cervical lymph nodes positive and pre-treatment prognostic nutritional index ≥ 52.0 could independently predict DMFS (p=0.036 and p=0.011), DSS (p=0.014 and p=0.026), and OS (p=0.002 and p < 0.001); Charlson comorbidity index < 3 points could predict DSS (p=0.011); age > 45 years (p=0.002) and pre-treatment lactate dehydrogenase ≥ 240 U/L (p < 0.001) predicted OS. No grade 4 late toxicity happened; grade 3 late toxicities included subcutaneous fibrosis (4.3%), deafness or otitis (4.8%), skin dystrophy (2.1%), and xerostomia (1.1%). No differences on survivals were shown between IMRT+CT vs. IMRT alone in stage II patients, even in T2N1M0 (p > 0.05). Unsurprising, patients in IMRT+CT had more acute gastrointestinal reaction, myelosuppression, mucositis, late ear toxicity, and cranial nerve injury (all p < 0.05) than IMRT alone group.Conclusion Superior tumor control and satisfying long-term outcomes could be achieved with IMRT in early-stage NPC with mild late toxicities. As CT would bring more toxicities, it should be carefully performed to stage II patients.

[Objective] To improve the success rate of spiral nasojejunal tube insertion through training of blind insertion of spiral nasojejunal tube with bare hands. [Methods] A total of 49 patients (5 of them were secondary intubation) who were admitted to the emergency department of our hospital from April 2, 2019 to June 17, 2021 needed to undergo blind hand intubation treatment with a nasal jejunal tube. The nurses who were recruited to participate in Guangdong. The enteral nutrition intubation training class hosted by the Provincial Nursing Society Critical Care Committee has been divided into two groups: the experimental group after training (n=28) and the control group before training (n=21) at the aim of comparing the success rate of one-time catheterization of patients in the two groups. [Results] The success rate of nurses' bare-handed blind insertion of the nasal jejunal tube increased from 43% to 86% (p

Objective To understand the current situation of emergency nurses’ specialty competence and propose improvement strategies accordingly, aiming to provide a reference for the comprehensive enhancement of nurse competency as well as the selection and training of high-level nursing management talents. Methods Using a self-made questionnaire based on literature review, 266 emergency specialist nurses in 15 tertiary general hospitals in Guangdong Province were surveyed through the questionnaire star. Results The survey showed that the participants appeared to have a high level of self-confidence and recognition for most indicators, as suggested by a high score (195.46±23.64), except for the aspect of scientific research ability. The scores of scientific research ability items ranged from 3 to 15 points (the 50th quantile was 9 points), and the score was 10.41±2.28 with a median score of 10, indicating that clinical nurses lacked confidence in scientific research abilities. The results of linear regression analysis suggested that gender, job title, publications in recent 5 years, and whether directly affiliated to a teaching hospital were the influencing factors that affect the competence of emergency nurses. Conclusions Scientific research ability is the major shortcoming of emergency specialist nurses. The influencing factors that affect nurses’ competencies include gender, professional title, publications in recent 5 years and whether directly affiliated to a teaching hospital. Nursing scientific research is the power source of the continuous development of nursing discipline. Therefore, it is recommended that the leaders of healthcare authorities and hospitals should strengthen the training of nursing scientific research and improve the scientific research ability of nurses.

Substantial morbidity and mortality are associated with postcardiac arrest brain injury (PCABI). MicroRNAs(miRNAs) are essential regulators of neuronal metabolism processes and have been shown to contribute to alleviated neurological injury after cardiac arrest. In this study, we identified miRNAs related to the prognosis of patients with neurological dysfunction after cardiopulmonary resuscitation based on data obtained from the Gene Expression Omnibus (GEO) database. Then, we explored the effects of miR-483-5p on mitochondrial biogenesis, mitochondrial-dependent apoptosis, and oxidative stress levels after ischemia‒reperfusion injury in vitro and in vivo. MiR-483-5p was downregulated in PC12 cells and hippocampal samples compared with that in normal group cells and hippocampi. Overexpression of miR-483-5p increased the viability of PC12 cells after ischemia‒reperfusion injury and reduced the proportion of dead cells. A western blot analysis showed that miR-483-5p increased the protein expression of PCG-1, NRF1, and TFAM and reduced the protein expression of Bax and cleaved caspase 3, inhibiting the release of cytochrome c from mitochondria and alleviating oxidative stress injury by inhibiting the production of ROS and reducing MDA activity. We confirmed that miR-483-5p targeted TNFSF8 to regulate the AMPK/JNK pathway, thereby playing a neuroprotective role after cardiopulmonary resuscitation. Hence, this study provides further insights into strategies for inhibiting neurological impairment after cardiopulmonary resuscitation and suggests a potential therapeutic target for PCABI.

Organic amendment has long been recognized as an effective approach to improve soil fertility and plant nutrition. Most studies on long-term organic amendment in fields have focused on cereals. The effects of long-term organic amendment on legumes remain largely unknown. Here we studied the impact of organic amendments, including straw and manure on the soil fertility, nodulation, seed yield, and seed quality in a 27-year experiment. The long-term fertilizer treatments were laid out using a randomized complete block design designed with three replications in the first year of experimentation (1990). Fertilization treatments were CK (no fertilization), NPK (inorganic nitrogen, phosphorus and potassium fertilizers), NPKS (Straw together with inorganic N, P, and K fertilizers), and NPKM (manure together with inorganic N, P, and K fertilizers). The layout was subsequently maintained in the following years to clearly understand the effect of long-term application of each treatment. Maize (Zea mays L.)-wheat (Triticum aestivum L.) rotation was the main long-term experiment cropping system from 1990 to 2011; from 2012 it becomes wheat-soybean (Glycine max L.) rotation. We found that NPKS, NPKM, and NPK increased organic matter by 34.7%, 36.24%, and 17.17%, respectively, and total nitrogen by 28.9%, 29.7%, and 25.2%, respectively, in comparison with CK. Organic amendment also increased enzymatic activity of phenol oxidases and β-1,4-glucosidases. The NPKS and NPKM increased soybean yields by 30.8% and 29.6%, respectively, in comparison with NPK alone and CK. The soybean yields significantly correlated with NO3-N, available phosphorus, available potassium and soil organic matter. Both the inorganic fertilizers and organic amendments did not significantly alter soybean nodule number and size. NPKS and NPKM applications significantly reduced fat content by 1.17% and 1.26%, respectively, as opposed to NPK fertilized treatments alone (0.34%), compared with those under CK, but did not affect soybean protein. Overall, the combination of straw returning with inorganic fertilizers and manure with inorganic fertilizers improves soil fertility and increases soybean productivity. However, organic amendments together with inorganic fertilizers might have an undesirable effect on soybean fat content. Organic amendments combined with NPK application have the highest value of protein content and increased nitrogen to the soil. High nitrogen reduced fat and increased protein content. Therefore, rate of N inputs should be adjusted under the application of organic amendments together with inorganic fertilizers in fluvo-aquic soil.

Purpose. A recurrent neural network (RNN) and its variants such as gated recurrent unit-based RNN (GRU-RNN) were found to be very suitable for dose-volume histogram (DVH) prediction in our previously published work. Using the dosimetric information generated by nonmodulated beams of different orientations, the GRU-RNN model was capable of accurate DVH prediction for nasopharyngeal carcinoma (NPC) treatment planning. On the basis of our previous work, we proposed an improved approach and aimed to further improve the DVH prediction accuracy as well as study the feasibility of applying the proposed method to relatively small-size patient data. Methods. Eighty NPC volumetric modulated arc therapy (VMAT) plans with local IRB’s approval in recent two years were retrospectively and randomly selected in this study. All these original plans were created using the Eclipse treatment planning system (V13.5, Varian Medical Systems, USA) with ≥95% of PGTVnx receiving the prescribed doses of 70 Gy, ≥95% of PGTVnd receiving 66 Gy, and ≥95% of PTV receiving 60 Gy. Among them, fifty plans were used to train the DVH prediction model, and the remaining were used for testing. On the basis of our previously published work, we simplified the 3-layer GRU-RNN model to a single-layer model and further trained every organ at risk (OAR) separately with an OAR-specific equivalent uniform dose- (EUD-) based loss function. Results. The results of linear least squares regression obtained by the new proposed method showed the excellent agreements between the predictions and the original plans with the correlation coefficient r = 0.976 and 0.968 for EUD results and maximum dose results, respectively, and the coefficient r of our previously published method was 0.957 and 0.946, respectively. The Wilcoxon signed-rank test results between the proposed and the previous work showed that the proposed method could significantly improve the EUD prediction accuracy for the brainstem, spinal cord, and temporal lobes with a p value < 0.01. Conclusions. The accuracy of DVH prediction achieved in different OARs showed the great improvements compared to the previous works, and more importantly, the effectiveness and robustness showed by the simplified GRU-RNN trained from relatively small-size DVH samples, fully demonstrated the feasibility of applying the proposed method to small-size patient data. Excellent agreements in both EUD results and maximum dose results between the predictions and original plans indicated the application prospect in a physically and biologically related (or a mixture of both) model for treatment planning.

Soil Olsen P level has a major influence on crop yield, efficient P utilization, and soil fertility. In this study, the optimum Olsen P range was determined from long-term (1990–2012) field experiments in three typical soil types of China under single cropping of maize or double cropping of maize and wheat. The critical soil Olsen P value for crop yield was evaluated using three different models, and the relationships among P use efficiency (PUE), Olsen P, and total P were analyzed. The agronomic critical soil Olsen P values obtained from the three models for the neutral soil of Gongzhuling and the calcareous soil of Zhengzhou were similar; however, the values from the linear-linear and linear-plateau models for both maize and wheat were substantially lower than those from the Mitscherlich model for the acidic soil of Qiyang. The PUE response change rates (linear equation slopes) under different soil Olsen P levels were small, indicating slight or no changes in the PUE as the soil Olsen P increased in all three soils. A comparison of the Olsen P levels that achieved the maximal PUE with the agronomic critical values derived from the three models indicated that the linear-plateau model exhibited the best performance. The regression equation coefficients of Olsen P response to total P decreased as follows: Zhengzhou (73 mg g−1) > Qiyang (65 mg g−1) > Gongzhuling (55 mg g−1). The Olsen P level increased as the total P increased, which may result in a decrease in PUE. To achieve a relatively high crop yield, PUE, and soil fertility, the optimum Olsen P range should be 13–40, 10–40, and 29–40 mg kg−1 at Gongzhuling, Zhengzhou, and Qiyang, respectively.

Chronic kidney disease (CKD) is a common chronic disease in the clinic. Patients are often at the risk of malnutrition due to impaired renal function [1-3]. In order to reduce the risk of malnutrition, it is advocated to implement nutritional therapy for patients with chronic kidney disease, but some patients have poor compliance and irregular dietary behavior, so effective intervention means are needed. Nutritional education is a specialized nutritional intervention measure. In order to assess the application effect of nutritional education in the nutritional therapy of chronic kidney disease, a randomized control trial was conducted on 100 patients with chronic kidney disease who received nutritional therapy in our hospital from August 2020 to October 2020.

In this study, we aimed to report a case of superior mesenteric artery syndrome, with a particular focus on the patient's non-surgical management including enteral nutrition therapy. The focus of this patient's care includes nasogastric tube management, parenteral and enteral nutrition care (personalized nutrition treatment plan), proper lying position, negative pressure drainage in the stomach, and psychiatric mental health nursing. This case study supports that with efforts focusing on patients’ nursing and enteral nutrition therapy, non-surgical management could be an effective approach in treating superior mesenteric artery compression syndrome.

Purpose Current guideline recommends a uniform method of delineation of subclinical disease within the primary clinical target volume (CTVp) for all stages of nasopharyngeal carcinoma (NPC). We performed a prospective observational study to investigate the outcomes with a reduced CTVp and radiation dose for early-stage NPC. Methods and Materials Patients with newly diagnosed, biopsy-proven World Health Organization type II-III and American Joint Committee on Cancer/Union for International Cancer Control sixth edition stage T1-2N0-1 disease were enrolled. All patients were treated with intensity modulated radiation therapy alone. We categorized CTVp into CTVp1 (high risk) and CTVp2 (low risk). CTVp1 comprised of gross tumor (on magnetic resonance imaging or contrast-enhanced computed tomography) plus a 5-mm margin (3-mm posteriorly) and was prescribed to 60 Gy in 30 fractions (fr). CTVp2 was generated from CTVp1 plus a 5-mm margin (3 mm posteriorly), excluding the maxillary and cavernous sinuses, and was prescribed to 54 Gy in 30 fr. The prescribed doses to the primary and nodal gross tumor volume (GTVp and GTVn) were 68 Gy in 30 fr and 60 to 66 Gy in 30 fr, respectively. Primary endpoint was local recurrence-free survival. This study was registered in ClinicalTrials.gov , number NCT03839602 . Results From May 2001 to August 2006, 103 patients were recruited and completed IMRT. With a median follow-up of 15.2 years (range, 2.1-18.1 years), only 1 patient had local failure. Ten-year local recurrence-free survival, regional recurrence-free survival, distant metastasis-free survival, and overall survival were 90.3%, 88.3%, 90.3%, and 91.2%, respectively. Among late IMRT-related adverse events, we recorded 2 patients with G1 cranial nerve injury, 3 patients with G3 hearing loss, and 3 patients with G3 subcutaneous fibrosis. No patients had temporal lobe necrosis, brain stem injury, or trismus. Conclusions Decreased CTV margins and radiation doses can achieve long-term tumor control with mild late toxicities for patients with early-stage NPC.

Ultrahigh dose-rate irradiation (FLASH-IR) was reported to be efficient in tumor control while reducing normal tissue radiotoxicity. However, the mechanism of such phenomenon is still unclear. Besides, the FLASH experiments using high energy X-ray, the most common modality in clinical radiotherapy, are rarely reported. This study aims to investigate the radiobiological response using 6 MV X-ray FLASH-IR or conventional dose-rate IR (CONV-IR).The superconducting linac of Chengdu THz Free Electron Laser (CTFEL) facility was used for FLASH-IR, a diamond radiation detector and a CeBrThe mean dose rate of 150 Gy/s and instantaneous dose rate of 5.5 × 10The radioprotective effect of 6 MV X-ray FLASH-IR was observed. The differences in inflammatory responses and redox status between the two groups may be the factors responsible for reduced radiotoxicities following FLASH-IR. Further studies are required to thoroughly evaluate the impact of ROS on FLASH effect.

To compare the incidence of xerostomia in nasopharyngeal carcinoma (NPC) patients treated with superficial parotid lobe-sparing intensity-modulated radiation therapy (SPLS-IMRT) and conventional IMRT (C-IMRT).Patients with histologically confirmed NPC who met the eligibility criteria were randomly assigned to receive either SPLS-IMRT or C-IMRT. The primary endpoint was the incidence of xerostomia at 12 months post-IMRT. The secondary endpoints included the xerostomia questionnaire (XQ) score, unstimulated salivary flow rate (USFR), stimulated salivary flow rate (SSFR), and survival outcomes.Ninety patients were enrolled. Eighty-two patients were included for xerostomia analysis (42 in the SPLS-IMRT group and 40 in the C-IMRT group). At 12 months post-IMRT, the incidence of xerostomia in the SPLS-IMRT group was significantly lower than that in the C-IMRT group (83.4% vs 95.0%; P = 0.007), especially the grade 3 xerostomia (0% vs 12.5%; P 0.001). The median change in XQ score was similar between the two groups (11.9 points vs 14.1 points; P = 0.194). There was a significantly higher median fractional USFR (0.67 vs 0.35; P = 0.024) and SSFR (0.66 vs 0.32; P = 0.021) in the SPLS-IMRT group than the C-IMRT group. The 3-year LRRFS, DMFS, and OS in the SPLS-IMRT and C-IMRT groups were 92.5% vs 90.9%, 83.8% vs 81.7%, and 88.9% vs 88.2% (all P 0.05).SPLS-IMRT significantly reduced the incidence of xerostomia at 12 months post-IMRT in NPC by recovering parotid gland function earlier than C-IMRT, without compromising survivals. Phase III clinical trials are warranted. (ClinicalTrials.gov, number NCT05020067).

With the increasing pressure on phosphorus (P) resources and global water eutrophication, the development of sustainable land management is pushed forward by detailed knowledge on the nature and fate of phosphorus (P) in agricultural soils under various long-term fertilizer regimes. Using bulk- (solution 31P nuclear magnetic resonance; P K-edge X-ray absorption near-edge, XANES) and micro- (X-ray fluorescence and XANES) spectroscopic techniques, we investigated the molecular speciation of P in an alkaline soil from plots under wheat-maize rotation with or without chemical P fertilizers for 26 years, since 1990. The long-term experimental results show that P buildup and drawdown were mainly in the inorganic forms in response to P addition and depletion. The added P increased P accumulation in the forms of brushite and deoxyribonucleic acid that preferentially depleted without P addition, indicating that these species were phytoavailable. Although P forms as hydroxyapatite and orthophosphate monoesters were increased under P fertilization, no significant depletions of these P forms were observed when P fertilization was withheld. In contrast, iron-associated P increased with and without P fertilization. These results from this long-term experimental site facilitate understanding of dynamics and availability of fertilizer P and the existing legacy P in soils, with important implications for sustainable P management in these soils and similar soils in other regions.

Calcareous soils are characterized by high pH and phosphorus (P) fixation capacity. Increasing application of P fertilizer recently has significantly improved soil P concentration, especially available P (Olsen-P) and inorganic phosphate (Pi) fractions. However, there are few data available on the ability of soils with different initial Olsen-P levels to continuously supply P (i.e., P desorption capacity) to crops without additional P fertilization and on which Pi fraction exerts the greatest influence on P desorption capacity. Five soils with different initial Olsen-P levels (0.5, 14.3, 38.4, 55.4, 72.3 mg kg−1, hereafter refer as OP1, OP2, OP3, OP4, and OP5) but similar other soil properties were selected to evaluate the capacity of P desorption and its relationship with Pi fractions. Soil P was sequentially extracted once daily for 16 consecutive days using Olsen solution. The content and proportions of dicalcium phosphate fraction (Ca2-P), octacalcium phosphate fraction (Ca8-P), aluminum phosphorus fraction (Al-P), and iron phosphorus fraction (Fe-P) in Pi increased significantly with the increase of initial Olsen-P (P

Background To analyse the survival and late toxicities of elderly nasopharyngeal carcinoma (NPC) patients treated by intensity-modulated radiotherapy (IMRT) with the high-total- and fractionated-dose simultaneous modulated accelerated radiation therapy (SMART) boost technique and to identify the effect of concurrent chemotherapy for these patients. Methods Two hundred and fifty-four elderly patients (age ≥ 60.0) with newly diagnosed non-metastatic NPC were retrospectively analysed. Statistical analyses were performed using the SPSS software program. Results The actual mean total and fractionated doses delivered to the gross tumour volume of the nasopharynx (GTVnx) were 74.55 Gy and 2.49 Gy, respectively. The 5-year locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-specific survival (DSS) and overall survival (OS) of the whole cohort were 93.0%, 85.7%, 83.2% and 74.1%, respectively. No grade 4 acute or late radiotherapy-induced toxicities were observed. Of 247 patients with stage II–IVb disease, 89 patients received radiotherapy (RT) alone, and 158 patients received concurrent chemoradiotherapy (CCRT), and the 5-year LRRFS, DMFS, DSS and OS of the RT-alone group vs. the CCRT group were 94.0% vs. 92.2%, 83.5% vs. 86.2%, 81.8% vs. 83.1% and 74.0% vs. 72.8% (all P > 0.05), respectively. Multivariate analyses showed that CCRT was not an independent predictor for LRRFS, DMFS, DSS and OS (all P > 0.05). Conclusion High-total- and fractionated-dose SMART boost IMRT could obtain a satisfactory long-term outcome with mild late toxicity in elderly NPC patients. The role of CCRT needs to be further studied to optimize the treatment strategy and improve the overall survival.

Soil organic carbon (SOC) is at the core of soil fertility. Although fertilization strategies can alter SOC stocks, their effects on SOC chemical composition is less known. Using the solid-state 13 C nuclear magnetic resonance (NMR) spectroscopy, we examined changes in the SOC chemical composition of three soils (0–20 cm depth) from an annual wheat-maize double-cropping system across central to south China. These soils had been subjected to 22 years (1990–2012) long-term fertilization. Compared with no-fertilization control, SOC stocks were significantly increased under chemical fertilization (NPK), NPK plus straw (NPKS), and NPK plus manure (NPKM). The O-alkyl C (labile C), not the alkyl C (persistent C), was consistently increased across the three fertilized treatments. Additionally, all fertilized treatments decreased the ratio of alkyl-C/O-alkyl-C (SOC decomposition index) or aliphatic-C/aromatic-C (SOC complexity index), indicating that the SOC decomposition was delayed, or SOC was converted into a more complicated structure. The soil C of NMR-determined functional groups (alkyl C, O-alkyl C, aromatic C, and carbonyl C) was positively correlated with the cumulative C input ( P 0.05). The conversion rate of functional groups was highest in O-alkyl C, indicating a largest contribution to the increase of SOC accumulation. Soil C:N ratio, pH, and clay were the main factors affecting the functional-group conversion rates, whereas annual precipitation, temperature, and accumulated temperature (>10 °C) played smaller roles. In conclusion, these results can be applied to the improvement of agricultural soil C sequestration capacity through changing SOC chemical structure under long-term fertilizer managements.

// Shuhang Xu 1, * , Lingling Feng 2, 3, * , Yongming Chen 2, 4, * , Ying Sun 2, 3 , Yao Lu 5 , Shaomin Huang 2, 3 , Yang Fu 6 , Rongqin Zheng 1 , Yujing Zhang 2, 3 and Rong Zhang 2, 7 1 Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China 2 State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China 3 Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China 4 Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China 5 Guangdong Province Key Laboratory of Computational Science, School of Data and Computer Science, Sun Yat-Sen University, Guangzhou 510006, China 6 Department of Statistical Science, Sun Yat-Sen University School of Mathematics, Guangzhou 510275, China 7 Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China * These authors have contributed equally to this work Correspondence to: Rong Zhang, email: zhangr@sysucc.org.cn Yujing Zhang, email: zhangyj@sysucc.org.cn Rongqin Zheng, email: zssyzrq@163.com Keywords: gastric cancer, lymph node stations, mapping, computer software, clinical target volume Received: November 30, 2016 Accepted: May 21, 2017 Published: June 08, 2017 ABSTRACT In order to refine the location and metastasis-risk density of 16 lymph node stations of gastric cancer for neoadjuvant radiotherapy, we retrospectively reviewed the initial images and pathological reports of 255 gastric cancer patients with lymphatic metastasis. Metastatic lymph nodes identified in the initial computed tomography images were investigated by two radiologists with gastrointestinal specialty. A circle with a diameter of 5 mm was used to identify the central position of each metastatic lymph node, defined as the LNc (the central position of the lymph node). The LNc was drawn at the equivalent location on the reference images of a standard patient based on the relative distances to the same reference vessels and the gastric wall using a Monaco® version 5.0 workstation. The image manipulation software Medi-capture was programmed for image analysis to produce a contour and density atlas of 16 lymph node stations. Based on a total of 2846 LNcs contoured (31–599 per lymph node station), we created a density distribution map of 16 lymph node drainage stations of the stomach on computed tomography images, showing the detailed radiographic delineation of each lymph node station as well as high-risk areas for lymph node metastasis. Our mapping can serve as a template for the delineation of gastric lymph node stations when defining clinical target volume in pre-operative radiotherapy for gastric cancer.

The Olsen phosphorus (Olsen-P) concentration of soil is generally a good indicator for estimating the bioavailability of P and environmental risk in soils. To maintain soil Olsen-P at adequate levels for crop growth and environmental sustainability, the relationship between soil Olsen-P and the P budget (the P input minus the output) as well as the variations of soil Olsen-P and P budget were investigated from three long-term (22 years) experiments in China. Five treatments were selected: (1) unfertilized control (CK); (2) nitrogen and potassium (NK); (3) nitrogen, phosphorous, and potassium (NPK); (4) nitrogen, phosphorous, potassium and straw; (5) nitrogen, phosphorous, potassium and manure. The results showed that without P fertilizers (CK, NK), there was a soil P deficit of 75–640 kg ha-1, and the lowest P deficit (mean of CK and NK) was in Eutric Cambisol. Soil Olsen-P decreased by 0.11–0.39 mg kg-1 year-1 in the order of Luvic Phaeozems > Eutric Cambisol > Calcaric Cambisol. Soil Olsen-P and the P deficit had a significantly (P Luvic Phaeozems > Calcaric Cambisol. Under the P fertilizer treatments (NPK, NPKS, and NPKM), soil Olsen-P showed an obvious surplus (except the NPK and NPKS in Luvic Phaeozems) of 122–2190 kg ha-1, and the largest P surplus was found under the NPKM treatment at each site. The relation between soil Olsen-P and the experimental years could be simulated using quadratic equation of one unknown in Calcaric Cambisol for the lower P input after 14 years of fertilization. And soil Olsen-P increased by 1.30–7.69 mg kg-1 year-1 in the order of Luvic Phaeozems > Eutric Cambisol. The relation between soil Olsen-P and the P surplus could be simulated by a simple linear equation except under NPK and NPKS in Luvic Phaeozems. With 100 kg ha-1 P surplus, soil Olsen-P increased by 3.24–7.27 mg kg-1 in the order of Calcaric Cambisol (6.42 mg kg-1) > Eutric Cambisol (3.24 mg kg-1). In addition, the change in soil Olsen-P with a 100 kg P ha-1 surplus (soil Olsen-P efficiency) was affected by the soil organic matter (SOM), pH, and CaCO3 content, etc. In the practice of fertilization, it’s not necessary to increase the amount of P fertilizers, farmers should take measure to solve the local problem, for adjust the soil pH of Eutric Cambisol and Calcaric Cambisol, and apply more nitrogen in Luvic Phaeozems. In the area of serious soil P surplus, it is encouraged to stop applying P fertilizers for a few years to take advantage of soil accumulated P and make the high Olsen-P content decrease to a reasonable level.

Combining organic materials with chemical fertilizers is gradually becoming the primary fertilization strategy in China for increasing soil phosphorus (P) concentration; however, the relationships between soil available P, P composition and phosphatase activities in treatments with long-term crop straw or animal manure combined with chemical NPK fertilizers are not fully understood. In this study, a field fertilization experiment was conducted in a light sandy loam soil from the Huang-Huai-Hai Plain of China to determine the variation in soil available P, P composition and phosphatase activities with 23 years of continuous application of maize straw or cattle manure in combination with chemical fertilizers at the depth of 0–20 cm, with special attention paid to their relationships. The experiment was arranged in a randomized block design with three replications for each treatment, including the unfertilized control (CK), chemical nitrogen (N) with phosphorus (P) and potassium (K) (NPK), NPK plus maize straw (NPKS), and NPK plus cattle manure (NPKM). Results indicated that all fertilization treatments significantly increased soil P concentration and crop yields. Among the fertilization treatments, NPKM treatment showed the significantly highest total P and available P concentrations, while no significant difference in either wheat or maize yield between NPK, NPKS and NPKM treatments was found. Compared to the application of chemical NPK fertilizers alone, the NPKS treatment significantly increased soil organic P, pyrophosphate and orthophosphate concentrations, as well as soil phosphatase activities. The increase in orthophosphate concentration under the NPKS treatment may be associated with the hydrolysis of organic P and pyrophosphate catalyzed by acid phosphomonoesterase (AcP), phosphodiesterase (PD) and inorganic pyrophosphatase (IPP), which was conducive to keeping soil available P concentration under NPKS treatment at an appropriate level that could not only satisfy crop P demand but also have no negative impacts on the environment. However, the increase of orthophosphate and available P concentrations under NPKM treatment may be primarily related to the manure P inputs, and although NPKM treatment significantly increased soil inorganic P concentration in comparison to other fertilization treatments, it also increased the risk of P leaching. Overall, from the perspective of P nutrient management, our results suggest that NPKS treatment might be an effective long-term fertilization practice in the light sandy loam soil of Huang-Huai-Hai Plain of China.

RothC and DNDC, two process-based agroecosystem models widely utilized for quantifying soil carbon (C) sequestration, were tested against datasets of soil organic carbon (SOC) measured in two long-term experiments with winter wheat-summer maize rotation at field soils in North China. In the study, the two models were utilized in conjunction in three modes, i.e., using DNDC alone, using RothC driven by soil C inputs of measured crop residue, and using RothC driven by soil C inputs derived from DNDC simulations. In general, results from the three ways of simulations were in agreement with the measured SOC dynamics for the two experimental sites with varied treatments. However, discrepancies in the results revealed the differences between the two models regarding their functionality. The simulations with RothC driven by the measured crop residue as C input produced the best results on SOC dynamics in comparison with observations. Results from the simulations with DNDC alone were less correlated to observations mainly due to the approximation of the modeled amount of crop residue. Due to the same reason, the simulations with RothC but driven by DNDC-modeled crop residue poorly fit to observations. The results conclude that given the similarity between RothC and DNDC regarding their routines modeling SOC transformations it is crucial for improving the models’ performance to provide accurate C input data (mainly crop residue) to the SOC turnover modules in the models.

The importance of soil saprotrophic fungi in agroecosystems is receiving increasing attention. However, the linkages between saprotrophic fungal communities and soil fertility and stoichiometry in agroecosystems are poorly understood. Here, four long-term field fertilization experiments with three treatments (i.e., no fertilizer (control), chemical nitrogen (N), phosphorus (P), and potassium (K) fertilizer (NPK), chemical combined with organic fertilizer (NPKM)) were performed to evaluate the associations of saprotrophic fungal communities with the soil fertility index (SFI) and stoichiometric carbon (C):N:P ratios. Long-term NPKM application increased the SFI by 57.66%–129.50% at the four sites, and the SFI was strongly correlated with the saprotrophic fungal community composition, which indicated that exogenous organic matter improved soil fertility to a large extent and stimulated the growth of saprotrophic fungi in arable soils. The soil C:P and N:P ratios were notably decreased in the fertilization treatment, indicated that P was sufficient. Further, the composition of saprotrophic fungi was significantly related to the C:N and N:P ratios, suggested that N status is an important factor for soil saprotrophic fungal communities. Our study provides empirical evidence that the saprotrophic fungal communities in arable soils are strongly associated with soil fertility and stoichiometry and offers guidance for improving soil fertility by regulating the saprophytic fungal community.

Agricultural fertilization plays a crucial role in crop production, and the fungal communities catalyze transformation of soil nutrients in support of crop production. However, it remains controversial about the optimal strategy for fertilizer inputs and the adaptive mechanisms of fungal communities across China. By using seven long-term field fertilization experiments in China, we analyzed crop yields, soil properties and fungal communities in soils that were treated for > 25 years with no fertilizer (control), inorganic fertilizers (NPK) and organic-inorganic fertilizers (NPKM). Long-term NPK resulted in significant acidification up to a decline by 1.20 pH units, while NPKM prevented acidification and increased pH up to 6.39 in three acidic soils with pH 8.11, both NPK and NPKM led to only marginal decline of soil pH, and NPK and NPKM showed comparable crop yields. Some members of Ascomycota in alkaline soils were both enriched by NPKM and NPK. Soil available P and C:N ratio, rather than pH, directly or indirectly affect crop yield in alkaline soils. High crop yield can be achieved by the sole use of inorganic fertilizers in alkaline soils, but acidic soil productivity should be maintained by organic amendment to counteract acidification by inorganic fertilization. Our study advances a mechanistic understanding for optimizing fertilization strategies towards sustainable agriculture under increasingly intensified fertilizer inputs.

Additional file 1: Table S1. Changes in target volumes and volumes of OARs between plan-I and plan-II. Table S2. Relative doses for targets and OARs between plan-I and plan-II.

Increasing amounts of crop residues are being returned to croplands. Understanding nitrogen (N) availability in crop residues under various N fertilization regimes is important in optimizing N management. Pot experiments were conducted to investigate the contribution, fate and residual effects of urea and maize residue-N using a 15N isotope technique. Four N regimes were tested: three basal-topdressing ratios of N applied as urea (100-0, 75-25, 50-50) and one basal application of 75% N as urea and 25% N as manure (75U+25M). An average of 31.4% wheat N uptake was derived from urea, 9.2% from maize residue, and 59.5% from the soil in the first season. During the growing stages of wheat, maize residue contributed 0.3-4.8% and 3.1-13.2% to soil mineral and microbial biomass N, respectively, and those originated from urea was 1.0-4.2% and 4.6-16.8%, respectively. Regarding the fate of urea and residue-N after the first season, 35.9% and 16.9% of urea-15N and residue-15N were recovered by wheat, 28.1% and 46.9% remained in the soil, and 36.0% and 36.2% were lost. The contribution of urea to crop N uptake and N recovery efficiency increased, while that of residue-N decreased with increasing proportion of topdressing N. Substituting 25% mineral N with manure decreased the urea-15N loss without negative effects on crop dry matter and N uptake. Residual urea-15N and maize residue-15N from the previous season contributed 3.9% and 3.0% to summer maize N uptake. Additionally, 29.3% of residue-15N remained in the soil after the second season, while only 18.6% of urea-15N remained. Our study suggests that fertilizer and crop residue are actively involved in soil N transformation and plant N nutrition, emphasizing the capacities of organic residues to sustainably supply nutrients. Considering the utilization of both N fertilizer and maize residue, we may suggest a 75-25 split in N fertilizer application, but more appropriate options need to be further assessed under different cropping systems.

Soil microbes and nematodes are important components of soil biota that strongly affect agricultural productivity and sustainability. Currently, our knowledge on the response of soil biota to agricultural management is restricted. This study aimed to identify the relationship between microbial and nematode communities and explore the resource path that flows within the soil micro-food web under different fertilization practices in a winter-wheat/summer-maize rotation system. The experiment was a randomized complete block design with three replicates for each treatment that included unfertilized control; inorganic N, P and K fertilizer (NPK); NPK plus manure; and NPK plus maize straw. Soil samples were taken at a 0–20 cm depth when wheat and maize were harvested. The results showed that organic manure or maize straw combined with NPK fertilizers had positive effects on the soil microbial and nematode communities. For example, the incorporation of straw increased the fungal biomass. Long-term inorganic fertilization might restrain nematode biomass accumulation especially in fungivorous nematodes. The analysis of the metabolic footprints of nematodes suggested that the incorporation of straw could enhance the carbon resource flow into the soil food web by enhancing nematode biomass. Structural equation modeling analysis suggested that the bottom–up control from the microbial community to the nematode community was more obvious in the wheat season in comparison with the maize season. In addition, a relatively stronger predation relationship was found between omnivores–predators and bacterivores rather than fungivores. Our study suggests that organic management combined with NPK fertilization could effectively enhance the association between microbial and nematode communities, while a crop rotation system with maize may have a negative influence on the structure of the soil micro-food web.

Temporal lobe injury (TLI) is a debilitating complication after radiotherapy for nasopharyngeal carcinoma (NPC), especially in patients who suffer treatment relapses and receive re-irradiation. We explored the clinical characteristics and prognostic factors of TLI in locally recurrent NPC (rNPC) patients after re-irradiation using intensity modulated radiotherapy (IMRT). A total of 454 temporal lobes (TLs) from 227 locally rNPC patients were reviewed. The clinical characteristics of TLI were analyzed. In the two radiotherapy courses, the equivalent dose in 2 Gy per fraction (EQD2) for the TLs was recalculated to facilitate comparison of the individual data. The median follow-up time was 31 (range, 3-127) months. After re-irradiation using IMRT, 31.3 % (71/227) of patients developed TLI. The median latency of TLI was 15 (range, 4-100) months. Univariate and multivariate analysis showed that the interval time (IT) between the two courses of radiotherapy and the summation of the maximum doses of the two radiotherapy courses (EQD2 - ∑max) were independent factors influencing TLI. The 5-year incidence of TLI for an IT ≤26 or26 months was 35.9 and 53.7 % respectively (p = 0.024). The median maximum doses delivered to the injured TLs were significantly higher than was the case for the uninjured TLs after two courses of radiotherapy (135.3 and 129.8 Gy, respectively: p0.001). The incidence of TLI with an EQD2 - ∑max125 Gy was5 %, and with an EQD2 - ∑max145 Gy it was50 %. A treatment mode limiting EQD2 - ∑max125 Gy with a2-year interval was found to be relatively safe.

Soil degradation and water pollution could have resulted from inappropriate phosphorus (P) supply. Soil Olsen P is generally a good indicator to estimate bio-availability of P and environmental risk in alkaline soil. The change in Olsen P is always strongly affected by soil organic carbon (SOC) when different forms of inorganic and/or organic P are applied to farmlands with chemical fertilizer and/or manure. We related soil Olsen P to apparent P balance (APB) and SOC in alkaline soils at three 15-year (1991–2005) fertilization sites of northern China. Six treatments were examined: unfertilized control, chemical nitrogen (N), chemical NP, chemical N plus potassium (NK), chemical NPK, and chemical NPK plus animal manure (NPKM, same total N but 20–80% more P). Compared to the initial Olsen P in 1990, after 15 years Olsen P was increased under P fertilization but decreased under no-P fertilization. At the three 15-year fertilization sites, annual mean Olsen P was 4.9–12.3 times higher under NPKM, 1.9–2.8 times higher under NP and NPK, but only 28.3–84.8% under Control, N and NK. Annual mean percentage of Olsen P to total P was higher under NPKM (4.6–8.1%) than under other five fertilizations (0.4–2.9%). Change in Olsen P significantly positively correlated with accumulated APB under all fertilizations (r2 = 0.10–0.31, P

Background Intensity modulated radiation therapy (IMRT) is the standard of care for nasopharyngeal carcinoma (NPC). Part of the IMRT quality assurance process involves accurate target volume delineation, which is crucial for local control and survival. Current practice utilizes a uniform contouring method for clinical target volume (CTV) for all stages of NPC. Here, we conducted a single-arm phase 2 trial investigating the tumor control rates of reduced CTV margins and corresponding doses in low-risk, early-stage NPC. Methods Patients with biopsy-proven stage I-IIb (6th UICC/AJCC) NPC were enrolled. All patients were treated with IMRT alone. Two CTVs (CTV1 [high risk] and CTV2 [low risk]) were outlined; CTV1 was defined by grossly identified tumour (on MRI or CT) plus 5-mm margin (3-mm posteriorly); CTV2 was CTV1 plus 5-mm margin (3-mm posteriorly). 60 Gy and 50–54 Gy in 30 fractions were prescribed to CTV1 and CTV2, respectively. Primary end-point was locoregional recurrence free survival (LRRFS). Results From May 2001 to August 2006, 103 patients were recruited; all patients completed IMRT as planned (time duration 39-61 days). At a median follow-up of 12.6 years, five patients developed locoregional failures; of which one was in-field, and four were regional recurrence (two in-field and two marginal). 10-year LRRFS, distant metastasis free survival (DMFS), disease specific survival (DSS) and overall survival (OS) were 95.0% and 94.1%, 94.0% and 91.1%, respectively. The most common grade 1-2 late toxicities included subcutaneous fibrosis (79.6%), hearing loss (53.4%) and skin dystrophy (43.2%); grade 3 included subcutaneous fibrosis (2.9%) and hearing loss (2.9%); and no grade 4 late toxicity. Conclusions Reduced CTV margins and corresponding doses results in optimal long-term tumour control, with minimal late adverse events. Clinical trial identification NCT03839602. Legal entity responsible for the study Chong Zhao. Funding National Natural Science Foundation of China [No. 81872469]; Science and Technology Project of Guangdong Province [No. 2014A020212433]. Disclosure M.L.K. Chua: Honoraria (institution), Advisory / Consultancy: Janssen, Astellas, Varian, Ferring Singapore and AstraZeneca; Research grant / Funding (institution), Structured research agreement/Research funding - Ferring Singapore, GenomeDx Biosciences, Varian, MedLever.: Ferring Singapore, GenomeDx Biosciences, Varian, MedLever. All other authors have declared no conflicts of interest.

Background: Young children are at a developmental stage, and any change in their body growth/development and nutritional status during this period has a direct impact on the prognosis of a specific disease. Clinically, most of the pediatric patients receiving an abdominal surgery are children with congenital malformations of the digestive system. They often have compromised nutritional status after the surgery due to factors including surgical trauma and stress reaction. Therefore, reasonable nutrition support has become a required intervention. In this prospective study, we investigated the influence of early enteral nutrition (EEN) on gastrointestinal (GI) function recovery and nutritional status after GI surgery in children. Methods: A total of 60 children with GI diseases undergoing surgical treatment in our center from January 2017 to December 2018 were enrolled in this study. They were randomly divided into the control group and the EEN group according to the order of admission. No EEN was applied in the control group; in contrast, the EEN group received EEN via percutaneous endoscopic jejunostomy (PEJ) tube and postoperative jejunostomy tube. The recovery of GI function, changes in biochemical indicators within 7 days after surgery, postoperative nutritional status, and complications were compared between these two groups. Results: After the surgery, the time to eating solid food and the time to first flatus/defecation were significantly shorter in the EEN group than in the control group (all P Conclusions: Proper EEN after a GI surgery can increase the survival rate, accelerate the recovery of GI function, and improve the nutritional status in pediatric patients. This intervention can be further applied in clinical settings.

Background: Forepassed trials have indicated that perioperative enteral immunonutrition can improve the clinical outcome for patients with digestive system cancer. The purpose of this study was to evaluate the effect of perioperative enteral immunonutrition on immunity and postoperative complications in patients with digestive system cancer. Methods: A group of 64 patients with digestive system cancer was randomly assigned for perioperative enteral immunonutrition (n=32) or standard enteral nutrition (n=32). The postoperative clinical outcome was assessed based on a clinical index, including postoperative complications, and systemic inflammatory response syndrome (SIRS) duration. Also, the postoperative cellular immunity was compared and evaluated between the two groups. Results: The nutritional therapy of both groups were completed. The occurrence of postoperative infectious complications in the immunonutrition group (6%) was significantly (P=0.020) lower than that of the standard nutrition group (28%). The duration of SIRS in the immunonutrition group (0.77±0.91 days) was significantly shorter than that in the standard nutrition group (1.34±1.46 days) (P=0.012). The postoperative lymphocyte counts and CD4+ T-cells counts significantly declined (P Conclusions: In comparison to standard enteral nutrition, perioperative enteral immunonutrition with glutamine (Gln), ω-3 fatty acids, nucleotide and arginine (Arg) improved the immune status of the patients, reduced the occurrence of postoperative infectious complications and decreased the duration of SIRS. CD4+ T-cells immunity possibly played a vital role in the inflammatory response and the modulation of postoperative immunity after surgery with digestive system cancer.