Objective To analyze the CT findings of pulmonary cryptococcosis (PC)in patients without HIV infection.Methods CT data of 26 patients with PC proved by pathology were analyzed retrospectively.All cases underwent plain CT scan,8 of whom underwent contrast-enhanced CT scan.Results 26 patients (17 male and 9 female),single lesion on CT was found in 11 cases,multiple nodules or masses in 10 cases,and mixed-type lesions in 5 cases.The lesion was located in left lung in 1 1 cases,in right lung in 7 cases and bilateral lungs in 8 cases.The lesions with burr sign were found in 1 9 cases,with cavities or vacuoles in 10 cases,and with halo sign in 8 cases.Enhanced CT showed marked heterogeneity in 1 case,moderate heterogeneity in 2 cases,slight enhancement in 3 cases and nonenhancement in 2 cases.Conclusion Lesions of PC with various CT findings are easy to be misdiagnosed as lung carcinoma or other lesions.CT-guided percutaneous lung biopsy is an effective method for diagnosis.

Objective To evaluate the therapeutic effect and safety of tandospirone and buspirone in the treatment of generalized anxiety disorder.Methods The clinical control study oftandospirone and buspirone in the treatment of generalized anxiety disorder was earched by PubMed,CBM,CNKI,VIP,and Wanfang Data,with deadline from January 2000 to June 2016.Meta-analysis was carried out using RevMan5.0 software to each effect index.Results A total of seven RCTs were included involving 615 patients were identified.Meta-analysis showed that the significant efficiency rate[P=0.34,OR=1.19,95％CI (0.83～1.69)] and HAMA[P=0.80,MD=-0.08,95％CI (-0.72～0.56)] of tandospirone and buspirone had no significant difference.Two groups of adverse drug reactions,dizzy,dry,constipine,insomnia,anorexia,and nausea had no significant difference (P＞0.05).Conclusion The efficacy and adverse reaction oftandospirone and buspirone in the treatment of generalized anxiety disorder are fairly.

Objective: To investigate postoperative recurrent pattern of the thoracic esophageal squamous cell carcinoma (TESCC), aiming to provide a basis for the delineation of postoperative radiotherapy volume for TESCC. Methods: Clinical data of 66 TESCC patients who recurred after the radical esophagectomy in Zhongnan Hospital of Wuhan University from 2011 to 2017 were retrospectively analyzed. According to the AJCC 8^th edition-defined classification of esophageal carcinoma, regional lymph node stations 1 to 8M were defined as the upper-middle mediastinum region (UMMR), and stations 8Lo, 9 and 15 were defined as the inferior mediastinum region (IMR), stations 16 to 20 were regarded as the upper abdominal lymph node region (UAR). Results: Among all 66 patients, 41 cases (62%) experienced loco-regional recurrence alone, 25 cases (38%) presented with distant metastasis alone. A total of 54 patients with 148 lymph node recurred after treatment. The highest risk region of lymph node recurrence was UMMR (118/148, 80%), after that, followed by UAR (24/148, 17%). With regard to 9 cases of UAR, 6 patients had lower TESCC, and 8 patients (89%) were graded as ≥ pathological stage Ⅲ. Conclusions The highest risk region of lymph node recurrence is UMMR in TESCC patients undergoing radical esophagectomy, which should be considered as the target volume in postoperative radiotherapy. For patients with lower TESCC ≥ pathological stage Ⅲ, UAR might be the target volume with cautions. Anastomosis and IMR are probably not the routine treatment volumes.

Objective:To develop a prediction model of acute gastrointestinal injury (AGI) grading combined with qSOFA score for the diagnosis of sepsis, and evaluate its value.Methods:This was a prospective observational study. The patients with infection or suspected infection in the General Ward of Changshu Hospital Affiliated to Soochow University from September 2018 to September 2019 were included. Patients younger than 18 years, pregnant, abandoned treatment and died within 3 days after admission were excluded. Clinical characteristics, laboratory test results and AGI grading from 48 h before the infection to 24 h after the onset of infection were recorded. The patients were divided into the sepsis and non-sepsis groups according to whether they were diagnosed with sepsis. The patients were allocated randomly to a modeling cohort and a validation cohort with a ratio of 7:3. Univariate and multivariate logistic regression analyses were used to analyze the relevant risk factors for sepsis in the modeling cohort. Three types of diagnostic models were constructed in the modeling cohort: model A (qSOFA model), model B (the combined model of AGI grading and qSOFA score), and model C (the combined model of clinical parameters). The clinical usefulness of the diagnostic models was assessed by receiver operating characteristic curve (ROC), calibration curve and decision curve analysis (DCA) in the validation cohort. The nomograms were developed based on these models.Results:A total of 2 553 patients were enrolled in the study, 1 789 patients in the modeling cohort and 764 patients in the validation cohort. and 326 were diagnosed with sepsis. There was no statistical difference in the basic conditions of patients in the two groups. Univariate analysis showed that age, gender, the source of infection, temperature, heart rate, polypnea, changes in consciousness, severe edema, hyperglycemia, white blood cell, C-reactive protein and procalcitonin, hypotension, hypoxemia, acute oliguria, coagulation disorders, hyperlacticemia, capillary filling damage or piebaldskin, AGI grading and qSOFA score were significantly correlated with sepsis (all P<0.01). Multivariate logistic regression analysis showed that age ( OR=1.027, P<0.01), source of infection ( OR=2.809, P=0.03), hypotension ( OR=35.449, P<0.01), hypoxemia ( OR=57.018, P<0.01), and AGI grading ( OR=19.313, P<0.01) were significantly associated with sepsis. ROC analysis showed that the area under the curve (AUC) of model A, B and C were 0.784, 0.944 and 0.971 in the modeling cohort, and 0.832, 0.975 and 0.980 in the validation cohort, respectively. The sensitivities were 63.9%, 89.5% and 97.5% in the modeling cohort, and 72.7%, 90.9% and 96.6% in the validation cohort; and the specificities were 90.8%, 90.3% and 88.1% in the modeling cohort, and 92.2%, 94.5% and 92.8% in the validation cohort, respectively. AUC of model B and C were significantly higher than that of model A ( P<0.01). Model A in the validation cohort was poorly calibrated, with low accuracy and high risk of missed sepsis diagnosis ( P=0.044). The net benefits of model B and C were better than that of model A. Conclusions:AGI grading combined with qSOFA score has a high predictive value and accuracy in the diagnosis of sepsis.

Objective:To research the metabolomic alterations of human lung bronchial epithelial cells infected with human rhinovirus 1B (HRV1B).Methods:Untargeted metabolomics was used to determine the metabolomic alterations in human lung bronchial epithelial cells (BEAS-2B) 6 h, 12 h and during the dynamic process (6 h∶12 h) after HRV1B infection.Results:A total of 93 differentially significant metabolites (DSMs) (47 DSMs were up-regulated and 46 DSMs were down-regulated) and 88 DSMs (37 DSMs were up-regulated and 51 DSMs were down-regulated) at post infection of HRV1B in BEAS-2B at 6 h or 12 h, respectively. A total of 30 DSMs (12 DSMs were up-regulated and 18 DSMs were down-regulated) in a dynamic process (6 h∶12 h) after HRV1B infection. Unknown metabolites took up most proportions. The trends of fatty acid, lipid, amino acid, nucleotide and carbohydrate were increased along with the prolonging of HRV1B infection. DSMs such as Diisononyl phthalate was co-detected DSMs among three groups.Conclusions:Metabolites such as fatty acid, lipid, amino acid, nucleotide and carbohydrate of BEAS-2B cells are changed induced by HRV1B infection.

Objective To investigate the effects and its possible mechanisms of tiopronin (TIP) on interleukin-2 (IL-2) immunotherapy of human leukemia KG-1 cells transplanted in nude mice.Methods KG-1 cells (1 x 107/ml) in logarithmic growth phase were injected subcutaneously into the groin of the left hind leg of the 45 5-week-old nude mice.When the subcutaneous tumor diameter was about 8 mm,nude mice were randomly divided into three groups (n =15):Control group (intraperitoneal injection of phosphate buffer),IL-2 group (hypodermic injection of IL-2),IL-2 + TIP group (hypodermic injection of IL-2 and intraperitoneal injection of TIP).The therapeutic effect of TIP combined with IL-2 on human leukemia KG-1 cells transplanted in nude mice was observed.The number of nature killer (NK) cells in peripheral blood of nude mice was detected by flow cytometry.Nitrate reductase assay was used to detect reactive nitric metabolite (RNM) levels in peripheral blood of nude mice.Enzyme linked immunosorbent assay (ELISA) was used to detect the levels of tumor necrosis factor-β (TNF-β) and interferon-γ (IFN-γ) in peripheral blood of nude mice.Terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL) assay was used to analyze apoptosis.Results Both IL-2 and IL-2 + TIP could inhibit the growth of transplanted tumor.Compared with IL-2 group [(54.32 ± 4.32) ％],the tumor inhibition rate of IL-2 + TIP group was (90.15 ± 3.75)％,and its inhibition of tumor growth was more obvious (t =11.893,P ＜ 0.001).The tumor weights of Control group,IL-2 group and IL-2 + TIP group were (0.95 ± 0.05)g,(0.58 ± 0.03)g and (0.27 ± 0.07)g,and there was statistically significant difference among the three groups (F =52.716,P ＜ 0.001).Compared with IL-2 group,the tumor weight of IL-2 + TIP group was significantly reduced (P =0.008).The number of NK cells in IL-2 + TIP group was (0.658 ±0.157)/L,which was significantly higher than (0.452 ±0.124)/L of IL-2 group (P =0.021).The concentration of RNM in IL-2 + TIP group was (42.92 ± 4.68)μmol/ml,which was significantly lower than (163.38 ± 5.49)μmol/ml in IL-2 group (P =0.007).The concentrations of TNF-β and IFN-γin IL-2 + TIP group were (247.68 ± 8.24) pg/ml and (185.61 ±7.58) pg/ml,which were significantly higher than (97.48 ± 7.28)pg/ml (P =0.021) and (70.62 ± 8.47)pg/ml (P =0.015) in IL-2 group.The apoptotic rate of tumor cells in IL-2 + TIP group was (47.38±4.25)％,which was significantly higher than (21.41 ±2.79)％ in IL-2 group (P ＜0.001).Conclusion TIP can increase the sensitivity of leukemia cells to IL-2 immunothe-rapy by removing RNM,promoting NK cells activity and increasing NK cells-induced tumor cell apoptosis.

Objective To evaluate the clinical efficacy and prognostic factors of stereotactic body radiotherapy(SBRT)for pulmonary oligometastases,and to further explore the patients most suitable for SBRT. Methods From 2012 to 2105,51 patients with 76 oligometastatic lung tumors were treated with SBRT.In those patients,27 had primary lung tumors and the others had extrapulmonary tumors. Seven patients had squamous cell carcinoma,thirty-five had adenocarcinoma, and the rest had other types of cancer. The patients received radiotherapy at a dose of 50 Gy in five fractions or 60 Gy in three fractions. Survival analysis was made by the Kaplan-Meier method. A multivariate analysis was made by the Cox model. Results The 1-and 2-year local control rates were 86%(65/76)and 80%(61/76),respectively. The 1-and 2-year overall survival(OS)rates were 80%(41/51)and 55%(28/51),respectively. The median survival time was 30(2-57)months,while the median progression-free survival time was 8(1-32)months. Twenty-one patients had grade 1 radiation pneumonitis(RP),while one patient had grade 2 RP. The multivariate analysis revealed that no more than 2 oligometastatic lung tumors,progression-free interval(PFI), and a performance score(PS)no higher than 1 were independent factors for OS(all P<0.05). Conclusions SBRT is effective and safe for treating pulmonary oligometastases. The number of oligometastatic lung tumors,PFI,and PS are independent prognostic factors for OS. Suitable patients and the appropriate timing of treatment are key to the efficacy of SBRT.

Objective To investigate the effect of E1A gene on the radiosensitivity of human nasopharyngeal carcinoma cells and its possible mechanism. Methods The E1A gene was transfected into nasopharyngeal carcinoma CNE-2R cells by adenovirus vector. The expression of E1A gene was detected by RT-PCR. Untransfected CNE-2R cells(PBS group)and CNE-2R cells transfected with empty vector Ad-β-gal(Ad-β-gal group)and E1A(Ad-E1A group)were given 0 Gy,2 Gy,4 Gy,6 Gy,8 Gy 6 MV X-ray irradiation. The changes in radiosensitivity of CNE-2R cells were determined by colony-forming assay. Flow cytometry was used to analyze cell apoptosis in each group. The expression of NF-κB, CK2α, Bcl-2, and cleaved caspase-3 was measured by Western blot. Results RT-PCR confirmed that the E1A gene was transfected into CNE-2R cells and stably expressed. The Ad-E1A group had a significantly lower plating efficiency than the PBS group and the Ad-β-gal group(P<0.05). The Ad-E1A group had significantly lower cell survival rate at 2 Gy irradiation than the PBS group and the Ad-β-gal group(0.217 vs. 0.602, P<0.05;0.217 vs. 0.585, P<0.05). The Ad-E1A group had a significantly higher α/β value than the PBS group and the Ad-β-gal group(24.680 vs. 5.268, P<0.05;24.680 vs. 5.132, P<0.05). Flow cytometry results showed that irradiation alone could promote the apoptosis of CNE-2R cells,when combined with E1A gene,the apoptosis rate was significantly increased(P<0.05). Western blot results showed that E1A gene down-regulated the expression of NF-κB/p65,CK2α,and Bcl-2 and up-regulated the expression of cleaved caspase-3. Conclusions E1A gene can enhance the radiosensitivity of nasopharyngeal carcinoma cells by inhibiting the expression of CK2 to block the NF-κB signaling pathway and promoting cell apoptosis.

ObjectiveTo evaluate the current situation of human resource allocation in district and county centers for disease control and prevention （CDCs） in Kashgar ， identify existing problems and influencing factors， and to provide scientific evidence for optimizing the human resource allocation. MethodsA survey was conducted among all CDCs in Kashgar in February 2022. The questionnaire included the institutional and individual questions. ResultsThe overall staff size approved for the CDCs in Kashgar was 604， with a staffing rate of 76.17%， among which the staffing rates in 5 county CDCs were less than 60%. Currently， there were a total of 524 approved staff members in all CDCs， resulting in a vacancy rate of 13.25%. In the district CDC， 85 staff members were on duty， while the median of staff on duty was 34 in each county CDC. The staff in the district CDC was ageing， of which those aged over 45 accounted for 67.06%. The staff in the county CDCs was generally young， of which those aged less than 35 accounted for 54.22%. Moreover， the proportion of staff with bachelor’s degree or above in the district and county CDCs was 31.76% and 24.95%， respectively. The proportion of staff without professional title was 32.94% and 48.03%， respectively. In contrast， the proportion of those with middle and senior professional title was 57.89% and 22.02%， respectively. In addition， in recent 3 years， 24 staff members resigned in the CDCs， all of whom had professional titles. ConclusionHuman resources are insufficient in CDCs in Kashgar. Furthermore， staff structure is unreasonable， with a serious loss of human resources. In particular， the district CDC needs to optimize the allocation of human resources.

Objective To investigate the effect of Tiopronin (TIP) on interleukin (IL)-2 immunotherapy of human leukemia KG-1 cells and its possible mechanism.Methods KG-1 ceils in logarithmic growth phase were randomly divided into KG-1 + IL-2 group and KG-1 + IL-2 + TIP group.Methyl thiazolyl tetrazolium (MTI) assay and colony formation assay were used to detect the sensitivity and proliferation of KG-1 cells.The changes of reactive nitric metabolites (RNM) were detected with nitrate reductase method.The production of tumor necrosis factor (TNF)-3 and interferon (IFN)-γ,was detected with enzyme linked immunosorbent assay (ELISA).The expression of CD3ξ was detected with Western blot and real time polymerase chain reaction (RT-PCR).Results IL-2 and IL-2 + TIP could inhibit the growth of KG-1 cells.The inhibitory rate of KG-1 + IL-2 + TIP group was significantly higher than that of KG-1 + IL-2 group,and the sensitivity of KG-1 cells to IL-2 was 6.2 times higher.Both IL-2 and IL-2 + TIP group inhibited the colony formation of KG-1 cells.Compared to KG-1 + IL-2 group,KG-1 + IL-2 + TIP group inhibited the colony formation of KG-1 cells by 3.5 times.The RNM production of KG-1 + IL-2 group was (158.26 ± 3.82) μmol/ml,which was significantly higher than (45.18 ± 4.29) μ mol/ml of KG-1 + IL-2 + TIP group (P ＜ 0.05).The levels of TNF-β and IFN-γin KG-1 + IL-2 + TIP group were (253.28 ± 7.84) pg/ml and (181.25 ±6.41) pg/ml,which was significantly higher than (98.45 ±6.43) pg/ml and (68.74 ±8.26) pg/ml of KG-1 +IL-2 group (P＜0.05).The expression of CD3ξ in KG-1 +IL-2 +TIP group was significantly higher than that in KG-1 + IL-2 group.Conclusions Tiopronin can promote NK/T cell activity and increase the sensitivity of leukemia KG-1 cells to IL-2 by eliminating reactive nitrogen metabolites.