Objective To compare the value of pacemaker implantation using the subclavian vein (SCV) puncture and thecephalic vein(CV) cutdown approach.Methods One hundred and forty-six patients were randomized into SCV group (98 patients) and CV group (48 patients).We observed the success rate,surgery duration,fluoroscopy time and complications of the two groups.Results The SCV group had significantly higher success rate,shorter duration of surgery and fluoroscopy than the CV group (success rate:100％ (98/98) vs.89％ (43/48),x2 =10.5,P ＜ 0.05 ; duration of surgery:(118 ± 35) min vs.(256 ± 75)min,t =12.12,P ＜0.01 ; duration of fluoroscopy:(15 ±5) min vs.(35 ± 10) min,t =13.08,P ＜0.01).Both groups had one case who developed compilations which were pocket hematoma and wire electrode dislocation respectively.The rate of complications was not significantly different between the two groups (P ＞ 0.05).Conclusion The SCV approach should be considered a preferable access in pacemaker implantation.

Objective To analyses the magnetic resonance imaging(MRI)findings of different clinical patterns of neurosyphilis(NS).Methods Clinical records and MRI of 26 patients with NS were retrospectively studied.Results Abnormal MRI was found in 17 patients of 26 patients with NS.In 7 patients were with meningo-vascular syphilis,the MRI commonly showed multiple cerebral ischemia focus and cerebral infarction focus,very few similar to those of encephalitis;Six patients had general paresis,who presented cerebral MRI abnormalities of frontal and temporal atrophy,and few simultaneously with cerebral ischemia focus,granular apendymitis and hippocampus sclerosis;Three patients had syphilitic myelitis,their MRI showed mild tumefaction with multiple ischemic focus all the way through lower cervical spinal cord to lower thoracic spinal cord:One patient was with tabes dorsalis,whose cerebral MRI showed ischemic locus.Another 9 patients had normal MRI,of whom 4 patients with meningitis NS and 5 with tabes dorsalis.Conclusion The MRI of neurosyphilis has diverse presentations,and clinicians should pay much attention to it.

Objective To explore the effects of different probe tone and tympanometric admittance measure-ment methods on the diagnose of otitis media prediction ,and to provide a clinical reference for the selection of probe tones and measurement method to apply to newborn infants .Methods Tympanograms with 226 Hz and 1 000 Hz probe tones were obtained from normal infants (142 ears) and infants with otitis media (90 ears) .Mean values , standard deviations ,the 90% range and 95% mean confidence interval were recorded as the variable to observe po-tential impacts on tympanometric admittance with 226 Hz probe tone and tympanometric peak admittance with 1 000 Hz probe tone by three different measurement methods respectively according to Linder/Jerger classification ,the Baldwin classification and baseline classification adapted from Baldwin .The four indexes were tested with compara-tive analysis .The area under ROC curve simultaneous detects the normal group and otitis media group ,with refer-ences to the accuracy of the detection method to disease (including specificity and sensitivity ) .Results In 1-to -3 month group ,tympanometric admittance with 226 Hz probe tone and tympanometric peak admittance with 1 000 Hz probe tone by three different measurement methods were 0 .83 ± 0 .29 ,0 .60 ± 0 .55 ,0 .74 ± 0 .56 ,0 .90 ± 0 .59 in nom-al infants and 0 .82 ± 0 .35 ,0 .01 ± 0 .06 ,-0 .24 ± 0 .15 ,-0 .29 ± 0 .21 in infants with OME ,respectively .The areas under ROC curve of the four kinds of measurement methods were 0 .507 ,0 .896 ,0 .976 ,0 .988 ,respectively .In 4 to 6 month group ,tympanometric admittance with 226 Hz probe tone and tympanometric peak admittance with 1 000 Hz probe tone by three different measurement methods were 0 .60 ± 0 .35 ,0 .55 ± 0 .58 ,0 .76 ± 1 .0 ,0 .86 ± 0 .72 in nomal infants and 0 .36 ± 0 .24 ,0 ± 0 ,-0 .34 ± 0 .16 ,-0 .44 ± 0 .28 in infants with OME ,respectively .The areas under ROC curve of the four kinds of measurement methods were 0 .749 ,0 .888 ,0 .969 ,0 .988 in 4 to 6 month infants ,re-spectively .Tympanometric peak admittance with 1 000 Hz probe tone by three different measurement methods were significantly better than that with 226 Hz probe tone .The areas under ROC curve of tympanometric peak admittance with 1 000 Hz probe tone by baseline classification adapted from Baldwin were bigger than others and the differences were significant(P<0 .05) ,but no difference between the Baldwin classification and baseline classification in 4 to 6 month infants(P>0 .05) .Conclusion Tympanometric peak admittance with 1 000 Hz probe tone were better than that with 226 Hz probe tone to assess otitis media in 1~6 month infants .The baseline classification adapted from Baldwin was appropriate for the measurement of tympanometric peak admittance with 1 000 Hz probe tone .

Objective To evaluate the clinical outcome and the acute toxicity in nasopharyngeal carcinoma (NPC) treated with tomotherapy followed by the anti-EGFR monoclonal antibody.Methods Between March 2008 and November 2009,34 newly diagnosed NPC patients were treated with helical tomotherapy combined with nimotuzumab or cetuximab.All the patients underwent tomotherapy at the dose of 70 Gy/33F for the gross tumor volume (pGTVns) and positive lymphnodes (GTVnd) ,and 60 Gy/33F for the high risk clinical target volume (PTV1),and 56 Gy/33 F for the low risk clinical target volume (PTV2),respectively.17 patients in group N were given weekly injection of 200 mg for 6-7 times and 17 patients in group C were given initial dosage 400 mg/m2 followed by subsequent weekly dosage of 250 mg/m2 for 6-7 times.Acute lesions were evaluated with the RTOG/EORTC criteria.Result The median follow-up time was 22 months.The effective rates (CR + PR) in 3,6 and 12 months were 14/17,12/17,12/17 in group N and 15/17,14/17,14/17 in group C.The 1 year survival rate was 15/17 in group Nand 17/17 in group C.Nimotuzumab had less acute mucositis reaction (u = 2.25,P < 0.05),weight loss(t=2.56,P=0.02) and rash (u=4.36,P＜0.01) compared with cetuximab.Conclusions Helical tomotherapy combined with nimotuzumab or cetuximab was effective and made no difference in the shortterm efficacy and 1 year survival rate for the patients with NPC.Nimotuzumab has less acute reaction than cetuximab.More studies should be done to prove long-term effects.

Objective: To evaluate the feasibility of hypofractionated intensity-modulated radiation therapy (IMRT) combined with concurrent chemotherapy in patients with locally advanced squamous cell carcinoma of the hypopharynx. Methods:Patients with stageⅢ-ⅣA carcinoma of the hypopharynx were treated with IMRT and cisplatin-based concurrent chemotherapy. Two groups were di-vided according to the prescription dose to the primary gross tumor volume, as follows:Cohort-1 comprised patients who were recruit-ed before February 2013 (70 Gy/33 F and 2.12 Gy/F);and Cohort-2 comprised patients who were recruited since February 2013 (69 Gy/30 F and 2.30 Gy/F). Acute toxicities were evaluated. This study was registered with the number ChiCTR-ONRC-14004240. Results:Between August 2008 and December 2014, a total of 76 patients (35 in Cohort-1 and 41 in Cohort-2) were recruited. No xerostomia of grade 3 and higher was observed in all patients, who showed low incidences of grade 3 skin reaction, oral mucositis, and dysphagia. All patients did not show acute toxicities of higher than grade 4. No statistical differences in acute toxicities were observed between the two cohorts. No statistical difference was observed in acute toxicities between the IMRT techniques. Induction chemotherapy was the inde-pendent prognostic factor for grade 2 xerostomia (P=0.002). Conclusion:The 69 Gy/30 F hypofractionated IMRT was safe and effec-tive in the treatment of locally advanced squamous cell carcinoma of the hypopharynx. Late toxicities and long-term outcome need to be investigated further.

OBJECTIVE: To analyze the judgement standard and evaluate the diagnostic value of the low frequency and high frequency tympanometry in infants with otitis media. METHOD: Tympanograms for admittance with 226 Hz and 1 000 Hz probe tones and resonant frequency were obtained from normal infants (195 cases, 321 ears) and infants with otitis media(122 cases, 171 ears). The mean, standard deviation, median, 5% quantile, 95% quantile and 95% confidence interval of peak admittance, gradient and resonant frequency were measured and calculated in different age groups. The significant differences of 1000 Hz peak admittance, 226 Hz peak admittance and gradient between normal infants and infants with otitis median were analyzed using SPSS 11.0. The false positive rate and the false negative rate of different age groups in infants with otitis media were evaluated according to such judgement standards as 1000 Hz peak admittance, 226Hz peak admittance or gradient. RESULT: The false positive rate and the false negative rate of the 1000 Hz probe tone tympanometry in infants with otitis media unter one year of age were 3.07% and 1.84% as the normal range of positive peak was more than 0.2 mmho. The false positive rate and the false negative rate of the 1000 Hz probe tone tympanometry in infants with otitis media aged 1-2 years and aged 2-3 years were 3.26%, 5.26% and 1.52%, 0.00% respectively,as the normal range of positive peak was more than 0.3 mmho. These was no significant difference in the gradient with 226 Hz probe tone between normal infants and infants with otitis median under one year of age. The false positive rate and the false negative rate of the 226 Hz probe tone tympanometry in infants with otitis media aged 1-2 years and aged 2-3 years were 44.57%, 31.58% and 16.67%, 6.67% respectively, as the gradient with 226 Hz probe tone was a judgement standard. CONCLUSION (1) The diagnostic accuracy of tympanometry with 1000 Hz probe tone for otitis media in infants younger than 3 years of age exceeded 226 Hz probe tone tympanometry, the 1000 Hz probe tone tympanometry is suggested to the evaluation of middle ear function in infants before 3 years. (2) It is reasonable that the normal range of positive peak is more than 0.2 mmho in infants unter one year of age and the normal range of positive peak is more than 0.3 mmho in infants aged 1-3 years.
Acoustic Impedance Tests ; methods ; statistics & numerical data ; Case-Control Studies ; Humans ; Infant ; Infant, Newborn ; Otitis Media ; diagnosis ; Reference Values

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

This study explores the effects of enhancing the definitive hematopoiesis(DH)signals during the differentiation of human embryonic stem cells(hESCs)into hematopoietic stem/progenitor cells on the generation efficiency and effector function of natural killer(NK)cells generated from hESCs(also known as hESC-NK cells).The hESC(H1)were transformed into embryoid bodies(Ebs)by centrifugation,and during the induction of K562,were used to analyze the efficiency of hematopoietic differentiation,the efficiency of NK cell generation from hESC,the in vitro effector functions,and the expression of effector function related surface receptors.Compared to the control group,the DH group had a significant increase in the number of arterial hematopoietic endothelial cells(CD34+DLL4+)and a significant decrease in primitive hematopoietic related cells(CD34-CD43+)on day 8 of hematopoietic differentiation(P<0.05).On day 28 of NK cell differentiation,the DH group demonstrated a significant increase in the number of NK cells(CD45+CD56+),while a slight increase in the expression of effector function-related molecules such as IFN-γ,Granzyme B,Perforin and CD107a without statistical significance.Furthermore,the activation receptors CD16a and CD69 were significantly increased,NKP46 was significantly decreased,the inhibitory receptor NKG2A was significantly increased,while CD96 was significantly decreased on hESC-NK cells of DH groups(P<0.05).Conclusively,enhancing the signals for definitive hematopoiesis during hESC differentiation into hematopoietic stem/progenitor cells significantly improves the yield of NK cells and the expression of CD16a without affecting their in vitro effector functions.Our study provides a new approach to improving the efficiency of hESC-NK cell or iPSC-NK cell generation.

Objective: To retrospectively analyze the laboratory findings and ultrasonographic features in acute phase of children suffering from Kawasaki disease (KD) with stable hemodynamics and Kawasaki disease shock syndrome (KDSS), so as to provide the evidence for early diagnosis, timely treatment and improvement of prognosis of KDSS. Methods: Four hundred and eighteen patients with KD diagnosed at Shenzhen Children′s Hospital from November 2016 to May 2018 were selected, including 23 KDSS patients(KDSS group) and 395 cases with stable hemodynamic(KD without shock group). The clinical characteristics, laboratory index and ultrasonic examination data of the 2 groups were collected and compared for statistical conclusion. Results: (1)The level of C-reaction protein(CRP)[166.20 mg/L (74.40 mg/L)], γ-glutamyl transpeptidase(γ-GT)[88.00 IU/L (126.00 IU/L)], creatine kinase isoenzyme(CKI)[1.78 μg/L (5.17 μg/L)], troponin(TP)[0.01 μg/L (0.39 μg/L)] in the KDSS group in acute phase were all higher than those in the KD without shock group[70.50 mg/L (54.30 mg/L), 40.00 IU/L (89.00 IU/L), 1.20 μg/L (0.85 μg/L), 0.01 μg/L (0.01 μg/L)], hemoglobin(Hb)[90.00 g/L (15.00 g/L)], ablumin [24.20 g/L (4.30 g/L)], serum sodium[130.90 mmol/L (5.60 mmol/L)] levels in the KDSS group were lower than those in the KD without shock group[107.00 g/L (14.00 g/L), 33.40 g/L (4.08 g/L), 136.10 mmol/L (3.25 mmol/L)], and the differences were statistically significant (all P<0.05). (2)The incidence rates of impaired left ventricular ejection fraction(LVEF)[<55%: 3 cases (13.03%) vs.8 cases (2.00%)], coronary artery abnormalities[left anterior descending branch(LAD) Z-score>2.5: 6 cases (26.09%) vs.35 cases (8.86%)]and valvular regurgitation[tricuspid regurgitation(TR)≥moderate: 3 cases (13.03%) vs.5 cases (1.26%)]in the KDSS group were higher than those in the KD without shock group, and the differences were statistically significant (all P<0.05). (3)Among acute phase in KDSS group, 9 cases (39.13%) had liver enlargement, 9 cases (39.13%) had peritoneal effusion, 3 cases (13.04%) had diffuse renal lesions, 3 cases (13.04%) had joint effusion (2 cases of knee joint effusion, 1 case of hip joint effusion), and 2 cases (8.70%) had enteritis.In the KD without shock group, only 3 cases (0.76%) had hepatomegaly and 2 cases (0.51%) had a small amount of knee effusion. Conclusions Laboratory findings of KDSS group showed higher level of CRP, CKI, TP as well as γ-GT than those in KD without shock group, who are more prone to suffer from hypohemoglobin, hyponatremia and hypoalbuminemia.Ultrasound examination showed that KDSS children were more prone to have heart or multiple-organ damage.Clinicians should raise their awareness to provide comprehensive assessment as well as timely and effective treatment.

The segmentation of organs at risk is an important part of radiotherapy. The current method of manual segmentation depends on the knowledge and experience of physicians, which is very time-consuming and difficult to ensure the accuracy, consistency and repeatability. Therefore, a deep convolutional neural network (DCNN) is proposed for the automatic and accurate segmentation of head and neck organs at risk. The data of 496 patients with nasopharyngeal carcinoma were reviewed. Among them, 376 cases were randomly selected for training set, 60 cases for validation set and 60 cases for test set. Using the three-dimensional (3D) U-NET DCNN, combined with two loss functions of Dice Loss and Generalized Dice Loss, the automatic segmentation neural network model for the head and neck organs at risk was trained. The evaluation parameters are Dice similarity coefficient and Jaccard distance. The average Dice Similarity coefficient of the 19 organs at risk was 0.91, and the Jaccard distance was 0.15. The results demonstrate that 3D U-NET DCNN combined with Dice Loss function can be better applied to automatic segmentation of head and neck organs at risk.