Objective To investigate the changes of serum levels of high-sensitivity C-reactive protein to distinguish community-acquired pneumonia caused by bacteria or mycoplasma pneumoniae in children.Methods To examine the serum levels of hs-CRP of patients with bacteria ( n =50),mycoplasma pneumoniae ( n =50),Virus ( n =50) by the Immunofluorescence method.and The levels of white blood cell(WBC),count of polymorphonuclear neutrophils(PMN) and neutrophil percentage(N) were analyzed.Results The levels of hs-CRP increased to different degrees in patients with bacterial pneumonia or mycoplasma pneumoniae pneumonia.the level of WBC,PMN and N have significant difference btween two groups also( all P ＜0.01 ).The area under the ROC curve(AUC) of hs-CRP was bigger than that of WBC,PMN and N(0.935 vs 0.783,0.807,0.747) and it was Significant difference(all P＜0.05).Conclusion Serum bs-CRP was a better biomarker in the early diagnosis of bacteria and it could effectively dstinguish community-acquired pneumonia caused by bacteria or mycoplasma pneumoniae in Children.

Objective To study the clinical effect of complex treatment combined with external application of Rhubarb and Mirabilite on abdomen of patients with abdominal distension after abdominal surgery .Methods 90 patients with abdominal distension after gynecological abdominal surgery from June 2014 to September 2015 were randomly divided into conventional group(45 patients) and comprehensive group(45 patients).Patients in the conventional group were given routine gynecological postoperative care, and patients in the comprehensive group were given complex treatment combined with external application of Rhubarb and Mirabilite on abdomen.The abdominal distension duration, anal exhaust time, time of resuming peristaltic sound, first defecation time, treatment effect, depression and anxiety emotions, changes of life quality of the two groups before and after intervention were compared.Results The comprehensive group had higher treatment effect than the comprehensive group ( P<0.05 ) .The abdominal distension duration, anal exhaust time, time of resuming peristaltic sound, first defecation time of the comprehensive group were shorter than that of the conventional group(P<0.05).The comprehensive group had better depression, anxiety emotions and life quality compared to the conventional group (P<0.05).Conclusion Complex treatment combined with external application of Rhubarb and Mirabilite on abdomen has a very significant clinical effect on patients with abdominal distension after abdominal surgery, it can improve patients’negative emotions and the symptom of abdomen distension, promote life quality.

In order to improve the efficiency and quality of medical services,the authors applied the lean production and system simulation into optimizing the transfusion system of a hospital.By means of describing and analyzing the current situation and problems of a transfusion system of the hospital,the paper presented the cause-effect diagram for overlong patient waiting.5W1H and ECRS were adopted to analyze the infusion processes,while Simio was used to simulate the existing infusion system and simulation data so obtained were used to draw a value stream mapping for the system.In line with the ideas of Shojinka and one stream production,nurses deployment and conveyor speed were reconfigured.Based on these ideas,a reform plan is presented and the simulation method is used to verify the outcomes.The study proved that lean production and system simulation can effectively improve the hospital transfusion system,medical efficiency and medical service level.

Objective To investigate the relationship between the ultrasonography diagnosis in prenatal and the postnatal placental vascular casts of the twins reversed arterial perfusion(TRAP) sequence. Methods Six cases of TRAP sequence underwent the two-dimensional and color Doppler ultrasonography, and performed placental vascular casts after termination of pregnance. Results According to the anatomical features and ultrasonography, there were 3 cases of acardius acephalus( IV) ,2 cases of acardius anceps( II ) , and 1 case of acardius acormus( I ). In all 6 cases,there were arterio-arterial and veno-venous anastomoses at the level of the chorionic plate between the normal co-twin and the acardiac twin,these anastmosis vessels were superficial and large calibre, and the distances of the placental insertions of the umbilical cords were different,4 cases <0. 5 cm, 2 cases were 4-5 cm. In 4 cases, the vessels entered and went out of the acardiac twin were just one large umbilical artery and one large umbilical vein. In 2 cases, the umbilical artery and umbilical vein had many vascular branches in the placenta. Out of 6 cases of the pump twin, 4 cases died,and 2 cases survived. Conclusions Ultrasonography was consistent with the placental vascular casts,the contrast observing gives us new information for the further research of the special type of the vascular anastmosis and prognosis of the TRAP sequence.

Objective To assess the value of contrast-enhanced ultrasound (CEUS) in differential diagnosis of BI-RADS-US 4 breast lesions.Methods A total of 123 lesions underwent CEUS.The CEUS features of lesions were categorized into 5 malignant or benign indexes respectively,lesions displaying any two of the five features were diagnosed as malignant or benign.The diagnostic effect of CEUS for BI-RADS-US 4 lesion was analyzed according to the pathological results as the gold standard.Results CEUS of the 123 BI-RADS-US 4 breast lesions indicated that 75 lesions were malignant while 48 were benign.Pathological results confirmed that there were 72 malignant lesions and 51 benign.The proportions of malignant lesions in 4A category,4B category and 4C category were 16.2 ％,58.5 ％ and 93.3 ％ respectively.The accuracy,sensitivity,specificity,positive predictive value,and negative and positive predictive value of CEUS for the diagnosis of BI-RADS-US 4 lesions were calculated as 92.7％,95.8％,88.2％,92.0％ and 93.7 ％ respectively.Lesions showing false positive in CEUS mainly needed surgical treatment,such as fibroma with active growth mesen-chyme,intraductal papilloma and granulomatous mastitts.Conclusions Surgical treatment rather than aspiration biopsy are suggested for those diagnosed being malignant in CEUS of the BI-RADS-US-4 lesions,as they can be treated as BI-RADS5 lesions.Short-term visit or aspiration biopsy are suggested for BI-RADS-US-4 lesions diagnosed being benign in CEUS.

ObjectiveTo observe the effect of VitalStim electrical stimulation on disorder of swallowing function induced by stroke.Methods60 patients with disorder of swallowing function after stroke were randomly divided into the treatment group and control group with 30 cases in each group. The patients in the treatment group were treated by VitalStim electrical stimulation and swallowing exercise and the cases of the control group were treated by swallowing exercise only. All patients were evaluated with the standard of swallowing exercise effect reported by Tengdao-Lang (Japan) before and after treatment.ResultsAfter treatment, the total recovery rate of the treatment group was 93.3%, that of the control group was 66.7%, there was a significant difference between two groups ( P<0.05).ConclusionThe effect of VitalStim electrical stimulation combined with swallowing exercise on disorder of swallowing function induced by stroke is better than swallowing exercise only.

Objective:To preliminarily evaluate the efficacy and safety of stereotactic body radiotherapy (SBRT) for pulmonary oligometastatic tumors from head and neck carcinoma.Methods:Clinical data of 24 patients with pulmonary oligometastasis from head and neck carcinoma undergoing SBRT in Zhejiang Cancer Hospital from January 2014 to May 2019 were retrospectively analyzed. Survival analysis was performed by Kaplan- Meier method. Results:Among the 24 patients, 12 cases were diagnosed with nasopharyngeal origin and 12 cases of non-nasopharyngeal origin. A total of 34 pulmonary metastatic lesions were treated with SBRT. The median follow-up time was 19.5 months. Thirteen cases developed new lesions after SBRT, and 9 of them occurred within 1 year after SBRT treatment. The actual 1-year local control rate was 95%. The median progression-free survival was 15.2 months, and the 1-and 2-year progression-free survival were 59% and 46%, respectively. The 2-and 3-years overall survival rate at were 71% and 51% fter lung metastasis, respectively. Univariate analysis showed that the patients with primary lesions located in nasopharynx and disease-free interval of more than 1 year had survival advantage. No more than grade 3 radiation-induced injury was observed in the whole cohort after SBRT, and the incidence of mild radiation-induced injury was 13%.Conclusions:SBRT is safe and effective in the treatment of pulmonary oligometastatsis from head and neck carcinoma, and it may be more effective for patients with primary tumors located in nasopharynx.

Background and purpose:The application of intensity-modulated radiotherapy (IMRT) has improved the local control rate of nasopharyngeal carcinoma greatly, which changed the predictive value of T classiifca-tions of TNM staging system. This study aimed to validate the predictive effect of T classiifcations in the 7th Union for International Cancer Control (UICC) staging system and discuss the simpliifcation of T classiifcations.Methods:We retrospectively reviewed the clinical data of 641 primary nasopharyngeal carcinoma patients at our center from January 2007 to June 2011. We evaluated the predictive effect of T classiifcations by Kaplan-Meier method and Cox regression model.Results:The 5-year overall survival (OS), local relapse-free survival (LRFS), progression-free survival (PFS) and distant metastasis free survival (DMFS) were 85.4%, 88.5%, 78% and 87.1%, respectively. The 5-year OS of T1, T2, T3 and T4 categories were 91.6%, 85.3%, 90.1% and 76.5%, respectively; LRFS were 93%, 85.3%, 91.5% and 84.4%; PFS were 88.2%, 77.3%, 80.8% and 70.9%; DMFS were 95.1%, 88.9%, 88.2% and 81.3%, respectively. The difference in survival curves between T1, T2 and T3 were not signiifcant (P>0.05). However, several prognostic indexes were signiifcantly different between T4 and T1, T2, T3. We merged the T1, T2 and T3 classiifcations as new T1, and the T4 classiifcation as new T2. The 5-year OS of new T1 and T2 were 89.1% and 76.5% (P=0.001); LRFS were 90.1% and 84.4% (P=0.028); PFS were 81% and 70.9% (P=0.001); DMFS were 90.8% and 81.2% (P=0.002). The survival curves were substantially separated. The simpliifed T classiifcations had obvious advantages when separately analyzed in different N stages.Conclusion:In the era of IMRT, the predictive effect of T classiifcations of the 7th UICC staging system has diminished. The simpliifcation of T classiifcations can ift with the new treatment and provide a better surviv-al prediction.

PURPOSE: The aim of the present study was to evaluate the prognostic value of magnetic resonance imaging (MRI)‒determined lymph nodal necrosis (LNN) in nasopharyngeal carcinoma (NPC) and explore the feasibility of an N-classification system based on the 8th edition of the American Joint Committee on Cancer (AJCC) system. MATERIALS AND METHODS: The MRI scans of 616 patients with newly diagnosed stage T1-4N1-3M0 NPC who were treated with definitive intensity-modulated radiotherapy (IMRT) were reviewed. RESULTS: Multivariate analysis showed that LNN was an independent negative prognostic predictor of distant metastasis free survival (hazard ratio, 1.634; 95% confidence interval, 1.023 to 2.609; p=0.040) and overall survival (hazard ratio, 2.154; 95% confidence interval, 1.282 to 3.620; p=0.004). Patients of classification N1 disease with LNN were reclassified as classification N2, and classification N2 disease with LNN as classification N3 in the proposed N-classification system. Correlation with death and distant failure was significant, and the total difference between N1 and N3 was wider with the proposed system. CONCLUSION: MRI-determined LNN is an independent negative prognostic factor for NPC. The proposed N classification system is powerfully predictive.
Classification ; Humans ; Joints ; Lymph Nodes ; Magnetic Resonance Imaging ; Multivariate Analysis ; Necrosis ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Radiotherapy, Intensity-Modulated

Objective To investigate whether the mucosal surface volume can be an alternative to the oral cavity volume for predicting grade 3/4 acute oral mucosal toxicity in patients with locally advanced nasopharyngeal carcinoma(LANPC). Methods A total of 92 patients with LANPC who underwent intensity-modulated radiotherapy(IMRT)and concurrent chemotherapy were enrolled in this study. The delineation of the oral mucosa was performed using oral cavity contours(OCC)or mucosal surface contours(MSC). Dosimetric comparisons of toxicity were performed based on the obtained dose-volume histograms(DVHs). The receiver operating characteristic(ROC)curve and logistic regression analysis were used to do statistical analysis of the data obtained from the two different contour methods. Results Both contouring methods showed a significant dose-volume association between oral mucosal exposure and acute oral mucosal toxicity. Logistic regression analysis showed that body weight loss was the independent associated factor for grade 3/4 toxicity in both OCC group and MSC group(P=0.017 and 0.005). And the independent correlation factors for dosimetric parameters in OCC group and MSC group were V30(P=0.003)and V50(P=0.003),respectively. The area under the ROC curve(AUC)of OCC at V30was 0.753(P=0.001)and the AUC of MSC at V50was 0.714(P=0.004). Conclusions DVH analysis of mucosal surface volume can accurately predict grade≥3 oral mucosal toxicity in patients with LANPC who receive IMRT and concurrent chemotherapy. However, OCC is superior to MSC in clinical application.