A case of spinal cord abscess caused by Nocardia cyriacigeorgica is reported. The patient is an elderly man with a history of nephritic syndrome who presented with aggravating lower back pain and then gradually developed urinary retention, weakness and numbness in both lower extremities. Operative intervention was performed, and postoperative pathological findings suggested spinal cord abscess formation. Metagenomic next-generation sequencing of the cerebrospinal fluid identified Nocardia cyriacigeorgica as the causative pathogen. Although appropriate antibiotics were prescribed, the patient died 3 months later.

Objective    To compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections. Methods    The patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed. Results    There was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041). Conclusion    Segmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.

Objective:To retrospectively analyze the blood leukocytes (WBC), lymphocytes (LYM), lymphocyte% (LYM%), and serum total immunoglobulin (IGA, IGG, IGM) and complement (C3, C4) index levels to explore its predictive value for the outcome of COVID-19 severe pneumonia.Methods:Eighty-five COVID-19 patients with severe pneumonia diagnosed in our hospital were randomly selected and were divided into good outcome group (50 cases) and poor outcome group (35 cases). WBC, LYM, LYM%, IGA, IGG, IGM, and C3, C4 level data, and analyze the differences between the two groups, the correlation of each indicator, and ROC curves of single and joint detection to explore relationship between indicators and outcomes, and the predictive efficacy of indicators on outcomes.Results:Differences in WBC, LYM, LYM%, IGG, and IGA levels were significant between the two groups ( P=0.000, 0.015, 0.000, 0.000, 0.001), among them with significant differences, LYM and LYM% were significantly positively correlated ( r=0.669, P=0.000), while WBC and LYM% levels were significantly negatively correlated ( r=-0.600, P=0.000), WBC and IGA levels were significantly positively correlated ( r=0.283, P=0.009) and IGG and IGA levels were also significantly positively correlated ( r=0.0.442, P=0.000); After logistic regression analysis, WBC, LYM, LYM%, IGG, and IGA are all important influencing factors ( P=0.001, 0.022, 0.000, 0.000, 0.003); but only the levels of WBC, IGG, and LYM% are Independent risk factors ( P=0.034, 0.004, 0.001), the ROC curve of the single detection and joint detection of their predicted outcome performance, respectively, and the max AUC (AUC=0.890, P=0.000) at the time of joint testing of WBC, LYM% and IGG, index YI=0.657, it has the greatest predictive power for adverse outcomes, with a sensitivity of 77.10% and a specificity of 88.00%. IGM, C3, C4, IGG/IGM, and C3/C4 levels were not significantly different( P=0.066, 0.204, 0.076, 0.310, 0.156). Conclusions:The levels of WBC, LYM, LYM%, IGG, and IGA in the early admission of COVID-19 infected patients with severe pneumonia have important predictive value for the outcome of them. WBC, LYM% and IGG levels are independent risks and joint detection of the three indexes have the best predictive performance.

Objective: To investigate the safety and efficacy of allogeneic CAR-T cells in the treatment of relapsed/refractory multiple myeloma (RRMM) . Methods: CAR-T cells were prepared from peripheral blood lymphocytes of HLA mismatch healthy donors. Median age was 55 (48-60) . Allogeneic cells were derived from 3 HLA haploidentical donors and 1 HLA completely mismatch unrelated donor. Four patients with RRMM were conditioned with FC regimen followed by CAR-T cell transfusion. They were infused into CART-19 (1×10⁷/kg on day 0) and (4.0-6.8) ×10⁷/kg CART-BCMA cells as split-dose infusions (40% on day 1 and 60% on day 2) . The adverse reactions and clinical efficacy were observed during follow-up after infusion, and the amplification and duration of CAR-T cells in vivo were monitored by PCR technique. Results: CAR-T cells were successfully infused in 3 of the 4 RRMM patients according to the study plan, and the infusion in one patient was delayed by 1 day due to high fever and elevated creatinine levels on day 3. The side effects included hematological and non-hematological toxicity, grade 3 hematological toxicity in 2 patients, grade 3 CRS in 1 one, grade 1 CRES in 1 one, prolonged APTT in 3 ones, tumor lysis syndrome in 1 one, mixed chimerism detected STR and clinical GVHD manifestation in 1 one. According to the efficacy criterias of IMWG, 2 patients acquired PR, 1 MR, and 1 SD respectively. Progression-free survival was 4 (3-5) weeks and overall survival was 63 (3-81) weeks. CAR T cells were amplified 2.2 (2-14) times in the patients with a median survival time of 10 (8-36) days. Conclusions Small sample studies suggested that GVHD may be present in the treatment of RRMM with allogeneic CAR-T cells. There were early clinical transient events after transfusion. Low amplification and short duration of CAR-T cells in vivo may be the main factors affecting the efficacy.

This paper, on top of its introduction of the concept of medical ethics counseling, analyzed the necessity of establishing a medical ethics consultation system in China.By reviewing the development of the medical ethics counseling system in other countries, the authors, in view of China′s medical practice, put forward specific recommendations on establishing a medical ethics counseling system in China.Issues on the construction of organ donation ethics counseling system in China were also discussed in focus.

Objective To evaluate the efficacy of routinely used pattern for schistosomiasis diagnosis in lake and marshland regions. Methods A historically heavy endemic village of schistosomiasis named Jinggan Village from Jiangling County was se?lected for field survey. The residents aged 6?65 years were screened by indirect hemagglutination assay(IHA)and dipstick dye immunoassay(DDIA)in parallel. The serological positives were examined by Kato?Katz technique and miracidium hatching technique to determine the infection of schistosome. The consistency of the two serological methods was evaluated. In addition , the schistosome infection rates were estimated according to the 3 detection patterns namely IHA,DDIA,IHA+DDIA combined with the etiologic examination. Results A total of 530 individuals were examined by the serological tests. The positive rate of DDIA was 46.98%(249/530),significantly higher than that of IHA(28.49%,151/530)(χ2=59.55,P<0.01). Totally 279 in?dividuals were serological positives determined by IHA or DDIA,while 252 of them were detected by stool examination,and 22 cases were determined as parasitological positives,while 7 and 3 cases were diagnosed as antibody negatives by IHA and DDIA,respectively. The estimated infection rates determined by IHA,DDIA,IHA plus DDIA combined with stool examination were 3.14%,3.97%、4.60%,respectively. Conclusions Under the condition of endemic situation becoming more and more waning,the current routinely used pattern for schistosomiasis detection may lead to missed diagnosis. So,more sensitive and ef?fective diagnostic tools or appropriate detection patterns need to be explored.

OBJECTIVETo analyze a child with developmental delay, severe mental retardation, speech delay and muscular hypotonia.

METHODSThe karotypes of the child and her parents were analyzed with G-banding analysis. Their genome DNA was also analyzed with array comparative genomic hybridization (array-CGH).

RESULTSNo karyotypic abnormality was detected at cytogenetic level. However, array-CGH has identified a de novo 4q21.21-q22.1 deletion in the child, which has a size of 12.1 Mb.

CONCLUSIONThe de novo interstitial 4q21.21-q22.1 deletion probably underlies the main clinical manifestation in the child. Array-CGH is useful for diagnosing children with multiple congenital anomalies with unclear etiology.

Child, Preschool ; Chromosomes, Human, Pair 4 ; Comparative Genomic Hybridization ; methods ; Female ; Gene Deletion ; Growth Disorders ; diagnosis ; genetics ; Humans ; Intellectual Disability ; diagnosis ; genetics ; Sequence Deletion

Child ; Chromosome Duplication ; genetics ; Craniofacial Abnormalities ; diagnosis ; genetics ; Facies ; Genetic Diseases, X-Linked ; diagnosis ; genetics ; Humans ; Intellectual Disability ; diagnosis ; genetics ; Male ; Methyl-CpG-Binding Protein 2 ; genetics ; Oligonucleotide Array Sequence Analysis ; Polymorphism, Single Nucleotide ; Sex Chromosome Disorders ; diagnosis ; genetics

OBJECTIVE: To observe the effect of adaptive replanning on adverse reactions and clinical outcome of nasopharyngeal carcinoma treated by helical tomotherapy. METHODS: Fifty nasopharyngeal carcinoma patients treated by TomoTherapy system were retrospectively analyzed. Among these patients, 25 received repetitive CT simulation and replanning, and another 25 case-matched control patients without replanning were identified by matching age, gender, pathological type, UICC stage, weight loss, etc. Wilcoxon test was used to evaluate the effect of replanning on acute and chronic radiation reactions within individuals. Kaplan-Meier study was used to estimate the survival of patients with or without replanning. RESULTS: There was a significant difference in late salivary grand damage between the replanning and the control group (P=0.046), while no difference was observed in acute or other late side effects between the two groups. The median follow-up of the two groups was 32 months (7-42 months) and 26 months (8-46 months), respectively. The median local relapse-free survival time, 2-year local relapse-free survival and 2-year lymphnode relapse-free survival in the two groups were similar (36 months, 92% and 100%). No significant difference was found in the 2-year metastasis relapsefree survival (80% and 96%) and the 2-year overall survival between the two groups (88% and 92%, P>0.05). CONCLUSION Adaptive replanning may reduce the severity of late damage of salivary glands after helical tomotherapy in nasopharyngeal carcinoma patients without improvement of 2-year survival rate.
Adult ; Carcinoma ; Carcinoma, Squamous Cell ; radiotherapy ; Female ; Humans ; Male ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; radiotherapy ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Intensity-Modulated ; adverse effects ; Retrospective Studies ; Survival Rate ; Treatment Outcome

OBJECTIVETo implement dose reconstruction and dose-guided intensity modulated radiotherapy for helical tomotherapy.

METHODSDose reconstruction was implemented on adaptive helical tomotherapy with the online megavoltage CT (MVCT) imaging from a patient with nasopharyngeal cancer. The differences of isodose line between actual and planned deposition were analysis in 3D distribution, on which the hot spot and cold spot were lined. The dose delivered to these areas was modulated in later fractions to keep the planned requirement.

RESULTSThe differences between actual and planned isodose line were shown on the image visually. The modulation to the hot spot and cold spot in later fraction corrected the incorrectly delivered dose to achieve the requirement of primary plan.

CONCLUSIONSThe dose reconstruction and dose-guided intensity modulated radiotherapy can be implemented in adaptive helical tomotherapy.

Humans ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Intensity-Modulated ; methods ; Tomography, Spiral Computed ; methods