Objective To develop the ribavirin purity certified reference material( CRM ) which has measurement traceability and high accuracy,and establish an effective method of evaluation. Methods The homogeneity and the stability were checked by differential scanning calorimetry(DSC). High performance liquid chromatography(HPLC)and DSC methods were used for purity determination of ribavirin. Results Ribavirin showed satisfactory homogeneity and stability. The certified value of ribavirin was 99. 5%with an uncertainty of 0. 4%(k=2,P=0. 95). Conclusion Ribavirin purity CRM obtained in this paper has been proven to be a national primary CRM with high accuracy and traceability,which can be used to validate analytical methods,improve the accuracy of measurement data,establish meteorological traceability of analytical results as well as control the quality of ribavirin in the pharmaceutical industry.

Based on the characteristic of nucleotide distribution in nucleosome positioning and inhibiting sequences, the method of Increment of Diversity with Quadratic Discriminant (IDQD) was applied to the classification of these two types of sequences. The mean area under ROC curve archives 0.958. By using this model, the nucleosome formation potential was analyzed in the regions around the splice sites (GT/AG). The results show that coding regions have a high potential to form the nucleosome and the primary RNA transcripts are rigid, while DNA sequences corresponding to the splice sites and their adjacent intron regions tend to be nucleosome free and the primary transcripts from these regions are relative flexible. Moreover, the negative correlation between nucleosome positioning/inhibiting of DNA sequences and RNA flexibility/rigidity is demonstrated around the splice sites, providing a mechanism for understanding the correlation between the nucleosome positioning of DNA and the splicing of transcribed RNA sequences.

OBJECTIVE To comprehend the main pathogens and their drug resistance of multiple organ dysfunction syndrome(MODS) patients in ICU.METHODS We retrospectively analyzed all the bacteria isolated from 40 MODS patients in ICU.RESULTS The number of bacteria strains isolated was 173,92 G-bacteria strains made up 53.18%,60 G+ bacteria strains made up 34.68%,and 21 fungi strains made up 12.14%.The top six were Staphylococcus aureus(23.70%,MRSA was 13.87%),Pseudomonas aeruginosa(14.45%),Acinetobacter baumannii(11.56%),Stenotrophomonas maltophilia(8.67%),Candida tropicalis(8.09%),and Enterococcus faecalis(7.51%).The susceptive rate of S.aureus and Enterococcus to vancomycin was all 100%,the susceptive rate of A.baumannii and Klebsiella pneumoniae to carbapenems was high.64% patients had the multiplicity of infection(MOI) which always linked with long period in ICU,respiratory failure and mechanical ventilation.CONCLUSIONS MODS patients have a high morbility of G+ bacteria,fungi and MOI,most pathogens show multi-resistance to commonly used antibiotics.Strengthening the monitoring of infection and reasonable using antibiotics should be taken.

Based on the conservation of nucleotides at splice sites, the characteristics of base composition and base correlation in the adjacent segment sequences, the distance between alternative donor or acceptor splice sites and the content of GC and TC near splice sites, the donor and acceptor splice sites for alternative and constitutive introns are predicted by use of the method of diversity measure combined with quadratic discriminant analysis. For alternative splice sites the total prediction accuracies are 87.9% and 89.9% for donors and acceptors respectively (with the chosen threshold -2). For constitutive splice sites the total accuracy are 92.8% and 94.3% for donors and acceptors respectively (with the chosen threshold -1).

Objective:To investigate and analyze the current status of multimodality therapy for resectable gastric cancer, aiming to provide reference for optimizing the multimodality treatment strategy for gastric cancer.Methods:Clinical data of patients diagnosed with gastric adenocarcinoma undergoing radical gastrectomy in the Second Affiliated Hospital of Soochow University were retrospectively analyzed. Clinical characteristics, preoperative medical comorbidities, pathological features, surgical and perioperative status and clinical efficacy were recorded. The gap between the diagnosis and treatment procedures and the standard guidelines was analyzed. The changes in the multimodality treatment patterns for gastric cancer were understood.Results:A total of 265 patients were included in this study. All patients were divided into two cohorts: early[2008] and late[2013] cohorts. In the early cohort, 127 patients were assigned, and 138 cases in the late cohort. In the early cohort, 67 patients (52.8%) underwent D 2 lymph node dissection, significantly less than 83 patients (60.1%) in the late cohort ( P<0.01). In the early and late cohorts, the proportion of patients with the number of lymph node dissection of ≥15 was 5.5% and 52.8%( P<0.01). The median number of lymph node dissection was increased from 6 to 16. The proportion of patients receiving neoadjuvant chemotherapy in the early and late cohorts was 2.4% and 3.6%( P=0.55). In the early cohort, the proportion of patients treated with postoperative chemotherapy and postoperative adjuvant chemoradiotherapy was 62.6% and 2.4%, significantly higher compared with 58.0% and 8.0% in the late cohort ( P=0.04). In addition, the proportion of patients receiving postoperative chemotherapy in the early cohort was 62.2%( n=79) and 58.0%( n=80) in the late cohort ( P=0.48). Conclusions:Although the level of radical gastrectomy has been continuously improved and standardized in China, which still lags behind the standard D 2 radical gastrectomy in Japan and South Korea. Adjuvant therapies including postoperative adjuvant radiotherapy can bring clinical benefits. However, the proportion of patients receiving adjuvant therapy is still low, and the multimodality therapy of gastric cancer should be widely applied.

Objective To compare the dosimetric differences between two plans of RapidArc and 5F-IMRT for breast cancer radiotherapy after breast-conserving surgery.Methods Eight female patients with left-sided breast cancer after breast-conserving surgery were selected.A dose of 50 Gy in 25 fractions was prescribed for plans of RapidArc and 5F-IMRT.Target conformity index (CI),homogeneity index (HI),target coverage,exposure dose volume delivered to organ at risk were compared between two plans.At the same time,treatment delivery time and monitor units (MU) were also compared.Results The target conformity index (CI) in RapidArc plan (·0.88 ±0.03) was higher than that in 5F-IMRT plan (0.79 ±0.02,t =8.28,P ＜ 0.05).The homogeneity index (HI) in RapidArc plan 9.01 ± 0.73 was significantly lower than that in 5F-IMRT plan10.44 ± 1.08 (t =-2.73,P ＜0.05).For the dose volume delivered to the ipsilateral lung in two plans,the values of V10,V20,V30,and Dmean in RapidArc plan were lower than those in 5F-IMRT plan(t =-7.53,-7.20,-8.39,-7.80,P ＜ 0.05).However,the value of V5 in RapidArc plan was higher than that in 5F-IMRT plan (t =5.67,P ＜0.05).For the heart,the values of V5,V10 and Dmean in RapidArc plan were higher than those in IMRT plan(t =10.46,28.76,5.40,P ＜ 0.05),while the value of V30 in RapidArc plan was lower than that in 5F-IMRT plan(t =-6.12,P ＜0.05).The values of V5 in contralateral lung and breast were higher in RapidArc plan than those in 5F-IMRT plan(lung:t =21.50,P ＜0.05;breast:t =5.44,P ＜0.05).The MU in RapidArc plan was decreased by 25％,and the average treatment delivery time was saved by 60％,compared with that of 5F-IMRT plan.Conclusions During breast cancer radiotherapy after breast-conserving surgery,compared with 5F-IMRT plan,the RapidArc plan could improve the target HI,and reduce both the irradiated dose in high-dose volume and MU,and shorten the treatment time,but increased the exposed volume in low-dose volume of normal tissues.

Objective To investigate the morphological regularity of the thoracic pedicle screw in 4 to 12 years old children by the digital technology,and to provide the theoreticl basis for thoracic pedicle screw fixation in children.Methods A total of 60 healthy children aged from 4 to 12 years old with computed tomography(CT) data of thoracic spine were divided into three groups by age,each group 20 cases.Then they were examined by MIMICS software and the parameters of pedicle width(PW),pedicle height(PH),the length of screw path(SL),e angle and f angle were measured.Results The pedicle width,pedicle height,the SL of the pedicle generally showed a rising trend with advancing age.There were significant differences in the PW,PH and LS between the three group(P<0.05).The PW decreased and then increased.The PH and the LS increased with the vertebral order increased.There was no significant difference in e angle and f angle between the three groups(P>0.05).E angle of the pedicle generally showed a decreasing trend with increasing vertebral order,and e angle of T11 to T12 showed negative angle.The f angle showed a wavy descending trend.Conclusion There was significant difference in correlation parameters of thoracic pedicle with increasing age in healthy children,which indicates that the pedicle screw fixation for the kind of children should be performed based on 'the Principle of individualization' to improve the success rate of surgery.

Objective To study the incidence and risk factors of infection caused by methicillinresistant staphylococcus aureus (MRSA) with a targeted surveillance at intensive care unit (ICU) acquired MRSA infection in Tianjin area.Methods A prospective multi-center observational analysis of consecutive patients admitted to 15 adult ICUs from March 1,2012 through March 31,2014 was carried out.The ICUs were divided into four groups according to the type of the ICU.All of the patients were cared for with routine MRSA surveillance.A number of risk markers and prognostic factors were recorded.The risk factors contributing to ICU acquired MRSA were evaluated using a logistic regression model.Comparison of survival between groups was analyzed with Kaplan-Meier method.Results A total of 1 787 patients were enrolled,and 144 cases of them were MRSA infections.The patients with MRSA infection were significantly older than those with non-MRSA infection (P =0.043),length of ICU stay,length of antimicrobial therapy,the history of repeated administration of antibiotics in recent days,history of operation in the past five years,history of MRSA infection or colonization,frequent application of and the overall length of time for mechanical ventilation and central venous catheter and catheter-associated infection were significantly higher than those with non-MRSA infection.The survival rate of patients with non-MRSA infection were higher than those with MRSA infection (x2 =9.23,P =0.004).The rate of MRSA infection and MRSA colonization in 2013 were significantly lower than that in 2012,because the rate of hand hygiene rule execution and bacterial clearance rate were significantly higher in 2013.Multivariate Logistic regression analysis demonstrated that advanced age (OR =1.05,95％ CI:1.009-1.086),length of ICU stay (OR =1.05,95％ CI:1.01-1.08),history of MRSA infection or colonization (OR =1.33,95％ CI:1.82 -3.27),glucocorticoid therapy (OR =2.85,95％ CI:1.18-6.91),antacid medicine (OR =4.92,95％ CI:1.18-20.58),history of recent or repeated application of antibiotics (OR =3.26,95％ CI:1.06-4.59) catheter-associated infections (OR =2.22,95％ CI:1.08-4.59) were associated with ICU acquired MRSA infections.Conclusions Performing the rule of hand hygiene strictly as well as strengthening prevention and control of MRSA infections can effectively reduce the incidence of ICU acquired MRSA infections.The advanced age,length of ICU stay,history of MRSA infection or colonization,glucocorticoid therapy,antacids medicine,history of recent or repeated application of antibiotics,catheterassociated infections were independent risk factors of ICU acquired MRSA infections.

Objective To analyze the infiltration of inflammatory cells under the mucosa of female cystitis glandularis and the different inflammatory infiltration in different clinical pathological types of cystitis glandularis.Methods Immunohistochemical method was used to detect the bladder mucosal tissue samples of 10 female patients confirmed cystitis glandularis admitted from June 2016 to October 2016.The results of immunohistochemical staining were collected and statistically analyzed by the automatic microscopy and image analysis system.In addition,the clinical data and tissue sample of 49 cases of cystitis glandularis treated from December 2006 to August 2017 were collected.Age of 49 patients was (34.4 ±7.5) years old and BMI was (21.9 ± 4.2) kg/m2.There were 19 cases of hypertension and 18 cases of diabetes.According to the cystoscopic manifestations,follicular edema type,papilloma type,and intestinal adenomatosis type were defined as high risk.Chronic inflammatory type and mucosa unchanged type were defined as low risk.Immunohistochemical staining was used to detect tissue samples,to compare the general data of different types of cystitis glandularis and the degree of infiltration of bladder mucosal inflammatory cells.Results T lymphocytes were highly expressed in 10 patients,and B lymphocytes and plasma cells were not expressed or extremely low (P ＜ 0.01).Of the 49 patients,29 were high risk type cystitis glandularis (follicular edema type,papilloma type,and intestinal adenomatosis type),and 21 were low risk type (chronic inflammatory type and mucosa unchanged type).The age of the high-risk group was (34.4 ± 7.5) years old with BMI of (21.9 ±4.2) kg/m2,8 cases of hypertension and 8 cases of diabetes.The age of the low-risk group was (38.2 ±8.5) years old with BMI of (20.8 ±4.0) kg/m2,11 cases of hypertension and 10 cases of diabetes.There was no statistically significant difference between two groups (P ＞ 0.05).The OABSS of high-risk group(10.4 ± 2.6) was significantly higher than that of low-risk group (7.1 ± 2.1,P ＜ 0.01).QOL of high-risk group (4.9 ± 0.9) was significantly higher than that of low-risk group (4.1 ± 0.8,P ＜ 0.01).Qmax of high-risk group was (11.4 ± 3.6) ml/s,significantly lower than that of low-risk group[(15.8 ±3.8) ml/s,P ＜0.01].The positive number of T lymphocytes of high-risk group was (173.5 ± 26.8),which was significantly higher than that of low-risk group(119.5 ± 21.2,P ＜ 0.01).Conclusions T lymphocytes infiltration is the major phenomenon in bladder submucosa of female patients with cystitis glandularis.The inflammatory infiltration by T lymphocytes could be associated with patient's symptom and bladder's pathological changes.

Objective:According to the SIOPE (2018) guidelines, the whole brain target of patients undergoing craniospinal irradiation was delineated and the underdose of sub-structures which were not delineated in original plan was verified, aiming to provide evidence for the risk of whole brain recurrence of craniospinal irradiation and accumulate experience for the clinical application of SIOPE guidelines.Methods:Twelve children who underwent craniospinal irradiation were selected. As per the SIOPE guidelines in 2018, the CTV sub (including the superior orbital fissure, foramen rotundum, foramen ovale, jugular foramen, hypoglossal canal, internal auditory meatus and optic nerve) were delineated based on the original CTV old (whole brain plus sieve plate) to form PTV new. A rough PTV (PTV rough) was formed by giving a margin of 15 mm forward-downward (skull base) and 3 mm in the other directions. CRT old and IMRT old plans were designed based on PTV old. CRT new and IMRT new plans were designed based on PTV new. CRT rough plan was designed based on PTV rough. The omission of sub-structures based on CTV old and the underdose of CTV sub in each plan were evaluated. Results:A total of 78.6% of superior orbital fissure, 71.99% of foramen rotundum, 96.76% of foramen ovale, 88.5% of jugular foramen, 97.71% of hypoglossal canal, 99.48% of internal auditory meatus and 100% of optic nerve volume were missed based on CTV old. The target dose coverage of CTV sub based on CRT old and IMRT old was only 91.70% and 89.83%, respectively. The underdose was observed in 16.66%, 3.57%, 20.83%, 1.78% and 1.19% of sub-structures in CRT old, CRT new, IMRT old, IMRT new and CRT rough plans, respectively. Of the underdose of all sub-structures, 38.36% and 46.58% occurred in CRT old and IMRT old plans, respectively. Among them, the least and the most significant underdose occurred in foramen rotundum (0%) and foramen ovale (36.66%), respectively. Conclusions:As per the SIOPE guidelines, traditional brain tissue delineation (including sieve plate) is likely to omit part of the target during the cranial target definition of craniospinal irradiation. The most significant underdose occurs in foramen ovale, and more obvious in the IMRT plan. The plan based on the delineation of sub-structures can significantly improve the underdose. When AP-PA irradiation is adopted, a rough PTV is recommended to obtain approximate target dose coverage and organ of risk sparing, whereas it requires further clinical verification.