Objective To analyze the anatomic changes and dosimetric variations of patients with head-and-neck cancer during intensity-modulated radiotherapy and to assess the necessity of re-planning the treatment course.Methods Twenty-one nasopharyngeal carcinoma patients were selected to receive the second CT scan in the course of intensity-modulated radiotherapy,targets and organs at risk were re-contoured on the new CT images with the help of deformable registration software.Actual dose distribution delivered by the original treatment plan was calculated on the second CT image,and then the volume and doses of targets and organs at risk were compared between the planning CT and second CT.Results The volume of patient's head-and-neck outlines and GTVnd decreased significantly,the volume of cord and brainstem didn't change much,while the volume of left and right parotids decreased significantly by (24.23 ± 12.15)％ and (25.82± 10.46)％,respectively.The parameters D95％ and Dmean of PGTVnx kept stable,but the parameters D1cc of spinal cord PRV and brainstem PRV increased by (8.12± 10.32)％ and (14.60±18.85)％ respectively.The mean dose of the left and right parotids increased significantly by (27.43±17.67)％ and (26.76±12.46)％,respectively.Conclusion The anatomical changes of patients undergoing intensity-modulated radiotherapy will cause significant dosimetric variations of the cord,brainstem and parotids,so it's meaningful and necessary to re-design the treatment plan in the course of radiotherapy.Repeat CT imaging and replanning during the course of IMRT is essential to ensure adequate doses to target volumes and safe doses to normal tissue.

Long bone osteomyelitis often results from serious open fractures or some closed fractures.Its treatment is a clinical difficultly in orthopaedics.Masquelet is a new strategy for bone reconstruction,validated by surgeons in their treatment of acute bone loss,bone tumor and bone infection.It is carried out in 2 stages.At the first stage,infection was eliminated by radical debridement and placement of antibiotic bone cement into the defect,which induces a pseudomembrane to facilitate the growth of bone graft.At the second stage,reconstruction of the bone defect is performed by bone grafting in the membrance after removal of the bone cement.The unique characteristics of this technique arouse more and more attention recently.Therefore,we would like to present a review about this Masquelet technique dealing with post-traumatic osteomyelitis of long bones.

Objective To analyze the impact of dose calculation resolution on Gamma pass rate for planar dose distribution verification of intensity-modulated radiotherapy (IMRT),and to find out the appropriate calculation resolution value with specific applied criteria.Methods 25 IMRT plans were selected for the planar dose verification.The Gamma pass rates with 3 mm/3％,2 mm/2％ and 1 mm/1％ criteria were compared and analyzed.The planar dose distributions were calculatedand exported from TPS with different resolutions of 0.5,1,2,3,4 and 5 mm.The pass rates of Gamma analysis between the computed dose distributions with different resolutions and the dose distributions measured by Mapcheck device were compared and analyzed.Results The average Gamma pass rates of all the 225 fields decreased with the increment of calculation resolution.When the pass rates of Gamma analysis were calculated using 3 mm/3％ criteria,the gamma pass rate with 1 mm and 0.5 mm calculation resolution were (98.3±1.3)％ and (98.3±1.2)％,respectively.The results were almost the same and the difference wasn't statistically significant (P＞0.05).The gamma pass rates with greater than or equal to3 mm calculation resolution were significantly less than the pass rate with 0.5 mm calculation resolution (P＜0.05).When the pass rates of Gamma analysis were calculated using 2 mm/2％ criteria,all the pass rates with greater than 0.5 mm calculation resolution were significantly less than the pass rate with 0.5 mm calculation resolution (P＜0.05).Conclusions The Gamma pass rates of planar dose verification reduce significantly with the increment of calculation resolution.In order to reduce the effect of calculation resolution on Gamma pass rate,the lower calculation resolution should be used.When using the 3 mm/3％ criteria for the Gamma analysis,1 mm calculation resolution is recommended.When using the 2 mn/2％ criteria for the Gamma analysis,0.5 mm calculation resolution is recommended.The appropriate calculation resolution will ensure the reliability of planar dose verification.

OBJECTIVE: To analyze HSP70/HSP27 protein expression in the nasopharyngeal carcinoma (NPC) primary tissues and the residual lesion, and to explore its predictive value. METHODS: Immunohistochemical experiment was performed to detect the expression of HSP70 and HSP27 in 58 NPC primary tissues: 28 were in the experimental group with the local residual lesion and 30 in the control group without recurring and metastasis within 5 years by conventional radiotherapy. RESULTS: The positive expression of HSP70 and HSP27 in the experimental group was 92.9%(26/28) and 53.6%(15/28), while that in the control group was 53.3%(16/30) and 53.3%(16/30),respectively. There was significant difference in the 2 groups. The common positive expression of HSP70 and HSP27 between the 2 groups had significant difference, 50.0% (14/28) in the experimental group and 16.7% (5/30) in the control group, respectively. There was no significant difference in the negative ratio of HSP70 and HSP27 common expression between the 2 groups, 3.6% (1/28) in the experimental group and 10.0% (3/30) in the control group, respectively. CONCLUSION HSP70 may have an important role in the radioresistance of NPC, and may predict the residual lesion after radiotherapy.
Adult ; Aged ; Carcinoma, Squamous Cell ; metabolism ; radiotherapy ; Female ; HSP27 Heat-Shock Proteins ; metabolism ; HSP70 Heat-Shock Proteins ; metabolism ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; metabolism ; radiotherapy ; Young Adult

Objective To establish a rapid,specific and sensitive TaqMan real-time fluorescence quantitative PCR assay for detection of murine polyomavirus ( MPyV) .Methods The specific primers and TaqMan probe were designed based on genome sequence of MPyV.The primers amplified a 69 bp fragment.After optimizing the reaction system and reaction condition, the standard curve was plotted by detecting recombinant plasmid standards.The specificity, sensitivity and reproducibility of this method were evaluated.In addition, samples of lungs, spleens and feces obtained from experimentally infected mice and 86 clinical samples were used to validate the efficacy of this real-time PCR assay.Results The specificity assay showed that this assay could specifically detect MPyV and the sensitivity for MPyV was about 100 copies/well.The coefficients of variation ( CV) of both intra-assay and inter-assay were less than 1.13%.All of the samples from experimentally infected mice were positive for MPyV and 3 out of 86 clinical samples were positive by this TaqMan-PCR detection with a positive rate of 3.5%.Conclusions The real-time fluorescence quantitative TaqMan-PCR assay established in this study has high specificity, sensitivity and stability.It can be used for clinical diagnosis, routine detection and epidemiological investigation of murine polyomavirus infections.

Liquid chromatography-multiple-reaction monitoring (LC-MRM) has been widely recognized as the golden standard for multiple components-targeted quantitative analysis of complicated matrices,with extensive applications for analysis in such fields as chemical drugs, traditional Chinese medicines and foods.Unfortunately, when facing the task of quantitatively analyzing trace chemical components in complex matrices, MRM suffers dramatically from the background noise or matrix interference, leading to undesirable sensitivity and selectivity in terms of the lower limits of quantification (LOQ) and detection (LOD).In recent years, MRM cubed (MRM3), also known as MS3 scan, has received much attention because of its unique ability to significantly improve detection selectivity and sensitivity attributing to the successive ion filtering function, enabling LC-MRM3 as an emerging analytical tool.In this review,our attention is devoted to: 1) the illustration of the principle for MRM3; 2) parameter settings; and 3) the application progress of LC-MRM3 in such fields as the pursuit of biomarkers, pharmaceutical analysis, forensic analysis, toxicological analysis, food chemistry, and environmental analysis, aiming to provide a promising analytical tool of LC-MRM3 advantageous in the quantification analysis of trace chemical components in complex matrices.

Objective:To investigate the clinical efficacy of membrane induction technique in the treatment of postoperative infection of tibial plateau fractures in adults.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 adult patients with postoperative infection of tibial plateau fractures treated with membrane induction technique from April 2013 to May 2017 in Southwest Hospital of Army Medical University. There were 19 males and two females, aged 19-60 years [(44.1±5.8)years]. There was one patient with type IV fractures, 14 with type V, and 6 with type VI according to the initial fracture typing by Schatzker's classification. There were three patients with infection period of within 3 weeks, 12 of 3-10 weeks, and 6 of over 10 weeks. All patients underwent two-stage operation using membrane induction technique to place cement in the bone defect area. After removal of internal fixation and thorough debridement, antibiotic cement and internal fixation plate were placed at stage I. Bone graft and reconstruction was performed at stage II. The infection indicators were recorded. Infection indices were monitored, including white blood cell count (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Clearance of infection, bony union and complications were evaluated. Range of motion (ROM) and scoring of Hospital for Special Surgery (HSS) were used to evaluate the function of knee joint.Results:All patients were followed up for 12-62 months with an average of 23.5 months. Compared with 3 months after stage II, the indicators of infection at stage I showed that WBC was decreased from (10.6±2.3)×10 9/L to (6.7±3.5)×10 9/L, ESR decreased from (26.0±5.3)mm/h to (12.1±4.3)mm/h, and CRP decreased from (10.0±1.5)mg/L to (5.8±1.0)mg/L ( P<0.05). Infection was cleared in 17 patients after stage I operation, and the other 4 patients had infection recurrence, which were given stage I debridement again to control the infection. Two patients were treated with local flap transfer to cover the wound because of skin soft tissue defect after debridement. Another two patients underwent knee arthrodesis, and none was amputated. X-ray film indicated bony union in 21 patients at 46 months (mean, 4.5 months) after operation, and clinical bone healing was acquired in all 21 patients. One patient showed donor site infection. No nonunion, recurrence of infection after stage II, deep vein thrombosis or pulmonary embolism occured after the second stage. At the latest follow-up, ROM in patients with infection periods within 3 weeks and 3-10 weeks was singnificantly improved from [(95.2±10.4)° and (85.7±11.5)°] to [(120.2±10.5)° and (98.6±12.2)°] ( P<0.01), but not in patients with infection periods of over 10 weeks ( P>0.05). The HSS score in all patients was significantly improved after operation [(65.6±8.2)points vs. (82.0±6.6)points]( P<0.01). Conclusion:For adult patients with tibial plateau fracture, membrane induction technique can effectively control the postoperative infection, achieve clinical bone healing and improve the knee function.

Objective:To investigate the risk factors of acute lung injury (ALI) caused by Staphylococcus aureus infection, and to construct a risk warning model. Methods:Patients with Staphylococcus aureus infection confirmed by sputum or blood culture admitted to the Affiliated Hospital of Jiangnan University from January 1, 2020 to May 10, 2022 were enrolled and divided into ALI group and non-ALI group. The age, smoking status, C-reactive protein (CRP), procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), albumin, oxygenation index and other clinical data were compared between the two groups. Univariate analysis was performed by using independent sample t test and chi-square test. Binary logistic regression analysis was used to screen the independent risk factors of ALI caused by Staphylococcus aureus infection, and a risk warning model was constructed. The receiver operator characteristic (ROC) curve was used to evaluate the predictive ability of the model. Results:There were 96 cases of Staphylococcus aureus infection, including 68 cases (70.8%) in ALI group, of which 41 cases (60.3%) were positive in sputum culture and 27 cases (39.7%) were positive in blood culture. Compared with the non-ALI group, the proportion of patients aged ≥60 years in ALI group was lower (58.8%(40/68) vs 64.3%(18/28)), the proportion of smoking was higher (58.8%(40/68) vs 35.7%(10/28)), and the differences were both statistically significant ( χ2=0.76 and 0.03, respectively, both P<0.05). The levels of CRP, PCT and NLR in the ALI group were all higher than those in non-ALI group, while oxygenation index and albumin level were both lower, and the differences were all statistically significant ( t=-5.28, -3.46, -9.87, 12.83 and 3.08, respectively, all P<0.05). Binary logistic regression analysis showed that CRP (odds ratio ( OR)=1.973, 95% confidence interval (95% CI) 0.956 to 2.989), PCT ( OR=3.734, 95% CI 1.014 to 13.746), NLR ( OR=1.152, 95% CI 1.058 to 2.254) and albumin ( OR=1.527, 95% CI 1.110 to 2.102) were independent risk factors for ALI caused by Staphylococcus aureus infection. The areas under the ROC curve of CRP, PCT, NLR, albumin and the risk warning model constructed from the combination of four risk factors were 0.69, 0.81, 0.83, 0.78 and 0.93, respectively. The sensitivities were 65.14%, 89.91%, 84.40%, 56.88% and 98.17%, respectively. The specificities were 62.37%, 60.22%, 65.59%, 80.64% and 93.55%, respectively. The accuracy of the effectiveness test of the risk warning model was 84.97%. Conclusions:CRP, PCT, NLR and albumin are the independent risk factors for ALI caused by Staphylococcus aureus infection. The risk warning model based on the above factors has a good early warning effect on ALI caused by Staphylococcus aureus infection.

Objective To observe the clinical efficacy of induced membrane technique combined with locking compression plate as an external fixator for the treatment of tibia infected defects.Methods Data of 107 patients with tibia infected defects who were treated by induced membrane technique combined with locking compression plate (LCP) as an external fixator in our department from June 2013 to May 2015 were retrospectively analyzed.Among them,62 cases' LCP were replaced with intramedullary nail during second stage (internal fixation group),while 45 cases kept their LCP (external fixation group).There were 52 males and 10 females in internal fixation group,aged from 18-61 (average,39.6),and their bone defects ranged from 3-17 cm (average,6.93 cm).15 cases were type Ⅲ and 47 cases were type Ⅳ according to Cierny-Mader classification.9 cases were suffered from hematogenous osteomyelitis and 53 cases suffered from trauma.15 cases located in proximal tibia,28 cases in middle tibia and 19 cases in distal tibia.There were 45 cases in external fixation group,aged from 18-65 (average,41.3),and their bone defects ranged from 5-12 cm (average,7.12 cm).13 cases were type Ⅲ and 32 cases were type Ⅳ according to Cierny-Mader classification.6 cases were suffered from hematogenous osteomyelitis and 39 cases suffered from trauma.12 cases located in proximal tibia,19 cases in middle tibia and 14 cases in distal tibia.Results All 107 patients have been successfully followed up for 18-40 months (23.5 in average).There were 20 patients (18.7％) encountered with a second debridement before grafting because of infection recurrence and culture positive was verified in 10 cases.101 cases acquired bone union,including 58 cases in internal fixation group and 43 cases in external fixation group.Average radiographic bone union time was 6.2 and 6.9 months in internal fixation group and external fixation group respectively.Nonuinon was observed in 6 cases (internal fixation group 4 cases,external fixation group 2 cases),with nonuion rate of 6.5％ (4/62) and 4.4％ (2/45).Infection reccurrence was found 3 cases in internal fixation group and 2 cases in external fixation group,with infection reccurence rate of 4.8％ (3/62) and 4.4％ (2/45) respectively.There were 5 cases observed pin track infection and 6 cases with pin track loosening in external fixation group.Conclusion Locking compression plate combined with induced membrane technique in the treatment of tibia infected defects can achieve a good clinical efficacy despite the complication of pin-track loosening and infection,unfavorable to the reconstruction of grafting bone.In internal fixation group,both radiographic bone union and clinical bone union were shorter comparing with external fixation group.So,intramedullary nail is a better choice of induced membrane technique during the second stage.

Rabdosia serra(R.serra),an important component of Chinese herbal tea,has traditionally been used to treat hepatitis,jaundice,cholecystitis,and colitis.However,the chemical composition of R.serra and its effect against colitis remain unclear.In this study,the chemical composition of the water extract of R.serra was analyzed using ultra performance liquid chromatography coupled with a hybrid linear ion trap quadrupole-orbitrap mass spectrometer(UPLC-LTQ-Orbitrap-MS).A total of 46 compounds,comprising ent-kaurane diterpenoids,flavonoids,phenolic acids,and steroids,were identified in the water extract of R.serra,and the extract could significantly alleviate dextran sulfate sodium salt-induced colitis by improving colon length,upregulating anti-inflammatory factors,downregulating proinflammatory fac-tors,and restoring the balance of T helper 17/T regulatory cells.R.serra also preserved intestinal barrier function by increasing the level of tight junction proteins(zonula occludens 1 and occludin)in mouse colonic tissue.In addition,R.serra modulated the gut microbiota composition by increasing bacterial richness and diversity,increasing the abundance of beneficial bacteria(Muribaculaceae,Bacteroides,Lactobacillus,and Prevotellaceae_UCG-O01),and decreasing the abundance of pathogenic bacteria(Turi-cibacter,Eubacterium_fissicatena_group,and Eubacterium_xylanophilum_group).Gut microbiota depletion by antibiotics further confirmed that R.serra alleviated colitis in a microbiota-dependent manner.Overall,our findings provide chemical and biological evidence for the potential application of R.serra in the management of colitis.