The wireless real-time monitoring system for body temperature is based on electronic thermometry and wireless communication technology. It can measure and store the patient's body temperature during the desired time span, and can transmit the data to the computer terminal or the cell phone terminal through wireless transmission system.

Objective To explore the prognostic value of serum C-reactive protein/albumin (CRP/ALB) ratio in the adult patients with sepsis.Methods A retrospective study was conducted.Clinical data were collected from septic patients who were at least 18 years old and whose intensive care unit (ICU) lengths of stay were at least 3 days,and who were admitted in the Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University in Henan Province from September 2013 to September 2015.These patients were divided into survival group and death group according to 28-day outcome.The serum CRP,ALB,and CRP/ALB ratio levels at the start of treatment (0 hour),24 hours and 72 hours after treatment in ICU were analyzed.And the receiver-operating characteristic (ROC) curve was plotted to assess the value of CRP,ALB and CRP/ALB ratio at different time points for predicting the outcome.Results Sixty-nine patients with sepsis were selected,among whom 28 cases were in the death group and the mortality was 40.6％.The characteristic of the baseline data in the two groups was balanced.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score at the first 24 hours of ICU admission in the death group were significantly higher than those in the survival group (APACHE Ⅱ score:25.18 ± 3.18 vs.17.88±3.20,SOFA score:11.71± 1.78 vs.9.17 ± 2.38,both P ＜ 0.05).And the ICU length of stay in the death group was significantly longer than that in the survival group [days:9.0 (2.5) vs.8.0 (3.0),P ＜ 0.05].The ALB level increased gradually as the treatment was extended in both groups while the levels of CRP and CRP/ALB declined gradually.The ALB levels at 0,24,72 hours after treatment in the death group were significantly lower,and the CRP and CRP/ALB levels were significantly higher than those in survival group [ALB (g/L):23.40 (4.20) vs.25.20 (8.20) at 0 hour,24.18±4.33 vs.28.54±4.88 at 24 hours,25.50±4.88 vs.34.88±7.23 at 72 hours;CRP (mg/L):179.32±34.04 vs.159.55±36.82 at 0 hour,160.08±22.91 vs.146.23±30.31 at 24 hours,159.36±25.81vs.142.53±36.30 at 72 hours;CRP/ALB:7.52±1.32 vs.6.04±1.46 at 0 hour,6.77±1.42 vs.5.23±1.24 at 24 hours,6.40± 1.34 vs.4.19± 1.21 at 72 hours;all P ＜ 0.05].ROC curves analysis showed that the area under ROC curves (AUC) of CRP/ALB at all time points were larger than those of CRP and ALB,with higher sensitivity and specificity;the AUC of ARP/ALB at 0,24,72 hours were 0.767,0.807,0.895,respectively;the cut-off values were 6.96,5.44,4.91,the sensitivity were 71.4％,85.7％ and 89.3％,and the specificity were 73.2％,63.4％ and 82.9％,respectively.Conclusions High serum CRP,CRP/ALB and low ALB in adult patients with sepsis indicate a poor prognosis,while the prognostic value of CRP/ALB is obviously better than the single value of CRP or ALB.CRP/ALB at 72 hours may be one of the best indicators for the assessment of clinical therapy and prognosis of patients with sepsis.

Objective To evaluate prognostic value of pentraxin3 (PTX3) content combining with extravascular lung water index (EVLWI) in patients with sepsis.Methods A retrospective analysis of complete clinical data of septic patients admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University from February 2013 to February 2014 was conducted.These patients were divided into two groups,survival group and death group,according to the outcome on the 28th day.Pulse index continuous cardiac output (PiCCO) was used to record the levels of EVLWI on the 1st,2nd and 3rd day of intensive care unit (ICU) admission.The plasma level of PTX3 was measured simultaneously by enzyme-linked immunosorbent assay (ELISA).At the same time,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) were calculated.Correlation analysis between plasma PTX3 and EVLWI values was performed,receiver operating characteristic curve (ROC) was drawn,and the prognostic value of each parameter was assessed finally.Results A total of 74 septic patients were enrolled,with 41 cases in the survival group and 33 cases in the non-survival group.Blood lactate,APACHE Ⅱ,SOFA scores in the non-survival group were significantly higher than those of the survival group at ICU admission,and the length of ICU stay was significantly shorter than that of the survival group,while differences of the other clinical characteristics between two groups were not statistically significant.The plasma PTX3 level gradually declined with time in both groups,and plasma PTX3 at 1,2,3 days after ICU admission in non-survival group were significantly higher than those in survival group [PTX3 (μg/L) at 1 day:46.3± 10.5 vs.19.4±6.5,t =-13.486,P =0.000; 2 days:34.8± 10.7 vs.17.7±8.4,t =-8.284,P =0.000; 3 days:23.9± 11.2 vs.15.6 ± 7.9,t =-5.036,P =0.000].EVLWI gradually declined in survival group,but increased in death group.EVLWI at 1,2,3 days after ICU admission in non-survival group were significantly higher than those in survival group [EVLWI (mL/kg) at 1 day:12.12 ± 4.31 vs.10.02 ± 2.87,t =-2.502,P =0.023; 2 days:13.67 ± 4.95 vs.9.08 ± 2.89,t =-5.188,P =0.000; 3 days:14.51±5.06 vs.8.09±2.50,t =-7.126,P =0.000].PTX3 at 1,2,3 days after ICU admission showed a significant positive correlation with EVLWI (r1 =0.747,r2 =0.719,r3 =0.705,all P =0.000).ROC curve analysis showed that the area under the ROC (AUC) of PTX3 at 1 day was 0.845 ± 0.045,at the cut-off point of 23.0 μg/L,PTX3 showed a sensitivity of 84.8％,a specificity of 74.1％,a negative predictive value of 85.81％,and a positive predictive value of 72.42％.AUC of EVLWI at 3 days was 0.838 ± 0.048,at the cut-off point of 10.5 mL/kg,EVLWI showed a sensitivity of 83.9％,a specificity of 82.9％,a negative predictive value of 86.45％,and a positive predictive value of 79.79％.Their sensitivities and specificities were found to be better than APACHE Ⅱ,SOFA score.AUC of PTX3 combined with EVLWI at 1 day was 0.886 ± 0.038.On the 1st day after ICU admission,with combination of the two indicators,cut-off point was found to be 0.312,a sensitivity of 86.8％,a specificity of 85.4％,a negative predictive value of 88.93％,and a positive predictive value of 82.72％.On the 3rd day after ICU admission,AUC of PTX3 combined with EVLWI was 0.856 ± 0.046,and showed a cut-off of 0.471 for the prognosis of sepsis,a sensitivity of 85.8％,a specificity of 85.4％,a negative predictive value of 87.97％,and a positive predictive value of 82.50％.Compared with other single index,a combination of above mentioned two indexes showed a better sensitivity and specificity.Conclusions PTX3 can serve as a novel prognostic indicator at early stage in septic patients.Combined with EVLWI,it shows important value in predicting prognosis of septic patients,and it also provides guidance in treatment of high-risk patients.

Objective To assess the value of SPECT/CT lung perfusion imaging (SPECT/CT-LPI) in evaluation of the regional lung function and the correlation between lung perfusion defects (LPD) and the clinical findings in NSCLC patients.Methods A total of 48 NSCLC patients (43 males,5 females;average age 61.06 years) who underwent pulmonary function tests (PFT),CT and 99Tcm-MAA SPECT/CT-LPI from December 2006 to March 2013,were retrospectively studied.LPD were divided into four grades:grade 0 (no lung perfusion defect was identified),grade 1 (the area of lung perfusion defect (LPDA) was similar to the size of local tumor),grade 2 (the LPDA was larger than local tumor and extends to 1 pulmonary lobe),grade 3 (the LPDA exceeded 1 pulmonary lobe).x2 test,one-way analysis of variance and Logistic regression analysis were used to analyze the correlation of the lung perfusion function and clinical findings.Results LPD were found in 44 patients (91.67％,44/48),including 18 with grade 1,15 with grade 2,11 with grade 3.The abnormal results of PFT were found in 16 patients (33.33％,16/ 48).The abnormal findings by SPECT/CT-LPI were more than that by PFT (x2=34.844,P＜0.01).The rates of LPD with grade ≥ 2 were significant different between patients with central lung cancer and those with peripheral lung cancer (x2 =8.392,P＜0.01),and between hilar lymph nodes positive group and negative group (x2=10.801,P＜0.01).The degree of LPD was related to tumor location (1 was assigned for central lung cancer,2 was assigned for peripheral lung cancer),tumor size (1 was assigned for maximum diameter ≤3.0 cm,2 was assigned for ＞3.0 cm and ≤5.0 cm,3 was assigned for ＞5.0 cm) and hilar lymph node (1 was assigned for with metastasis,0 was assigned for no metastasis) (Wald=8.176,5.352,10.100,all P＜0.05).Conclusions Compared with PFT,SPECT/CT-LPI has a more significant value in assessment of the regional lung function in NSCLC patients.Tumor location,tumor size and metastasis of hilar lymph nodes may be helpful for LPD grading.SPECT-LPI may be beneficial for patients with central lung cancer,large tumor and hilar lymph nodes metastasis.

Objective To assess the accuracy (ACC),sensitivity (SEN),and specificity (SPE) of dose-volume histogram (DVH) parameters in predicting the radiation pneumonitis (RP) using receiver operating characteristic (ROC) curve.Methods Complete clinical data of 118 non-small cell lung cancer patients treated with three-dimensional conformal and intensity-modulated radiotherapy plus chemotherapy were included.Chi-square and logistic regression were retrospectively applied to analyze the correlations between DVH parameters [relative lung volume received ≥ 5 Gy (V5),10 Gy (V10),13 Gy(V13),20 Gy (V20) and 30 Gy (V30) and mean lung dose (MLD)] and grade 2 (and above) RP defined by the National Cancer Institute Common Terminology Criteria for Adverse Events,version 3.0.ROC curve was adopted to investigate the predictive ACC,SEN and SPE of potential DVH parameters associated with RP.Results Total lungs V5,V10,V13,V20 and MLD were all correlated to the development of RP (x2 =4.786,5.771,6.366,7.367 and 6.945,P ＜ 0.05) according to univariate analysis.However,total lungs V30,patient characteristics (age,sex,KPS,tumor location,pathology) and treatment factors (prescription dose,radiotherapy technique,chemotherapy method and timing) were not contributors to RP.Logistic regression showed that V20 of both lungs remains tight by associated with RP (x2 =10.96,OR =4.16,95％ CI 1.40 ～ 12.36,P ＜0.05),although significant colinearity was found between V20 and other DVH parameters (r =0.767-0.902,P ＜0.05).ROC curve confirmed that V20 of both lungs could act as a predictor for RP (Z =2.038,P ＜ 0.05).The predictive ACC,SEN,and SPE were 0.645 (95％ CI0.498-0.793),0.650 (95％ CI0.408-0.864),and 0.674 (95％ CI0.571-0.765),respectively.However,the positive predictive value was only 28.9％.Conclusions V20 of both lungs was correlated to the development of RP.It could act as a predictor for RP though the predictability is limited.

Objective To explore the relationship between pressure source and mental healthy of freshmen in medical college. Methods 1324 freshmen in medical college were assessed with Beck-Srivastava stress inventory (BSSI) and checklist 90 (SCL-90) to detect the pressure source and mental health state. Relative analysis and regression analysis was used to statistic differences. Results The BSSI total score was from 49 to 119,mean score was (77.68 ± 12.47 )of freshmen in medical college. It was obviously higher than critical pressure.The 6 factors score of SCL-90 in somatization, compulsion, interpersonal relationship, depression, anxiety and hostility were significantly higher than Chinese domestic norms, the difference has a statistical significant (P ＜0. 01 ). The 7 factors score of somatization, compulsion, interpersonal relationship, depression, anxiety, hostility and fear in male freshmen were higher than those in female freshmen, the difference has a statistical significant (P＜ 0. 05 or P＜ 0.01 ). Relative analysis and regression analysis results showed that 5 factors of BSSI entered the regression equaltion. Conclusion The mental health problems of freshman in medical college were relatively serious, and the college should be pay special attention to the problem and intervene early.

Objective To assess the efficacy and the adverse effects of improved late course accelerated hyperfractionated radiotherapy (LCAHRT) combined with cisplatin-based chemotherapy for locally advanced esophageal squamous cell carcinoma (ESCC).Methods 68 Patients with pathologically confirmed ESCC were enrolled.Conventional fractionation was implemented to 40 Gy/20 fractions,followed by LCAHRT delivered 2 fractions of 1.4 Gy with an interval of 6-8 hours per day to 14 fractions,thus the total dose was 59.6 Gy.Two cycles of cisplatin-based chemotherapy were administered concurrently,followed by two more cycles.The short-term efficacy of treatment,overall survival for 1-,3-,5-year,and treatment-related toxicity were evaluated.Results All patients successfully completed LCAHRT and the overall response rate was 91.6％ (62/68).The overall survival rate of 1-,3-,and 5-year was 75.5％,46.5％,22.7％,respectively.The incidence of radiation esophagitis (grade 3 or greater) was 26.4％,and no patients developed grade 3 or worse radiation pneumonitis.The radiation-induced skin injury were most of grade 0 or 1.Grade 3 of leucopenia and neutropenia were observed in 29.4％ and 7.4％ of patients,respectively,and grade 4 were both in 2.9％.During long-term follow-up,no esophageal stenosis and severe pulmonary fibrosis was developed except for two cases(2.9％)of esophageal mediastinal fistula.Conclusion Late course accelerated hyperfractionated radiotherapy combined with chemotherapy yields promising long-term survival,with lower treatment-related toxicity for patients of locally advanced esophageal squamous cell carcinoma.

Objective To compare the dosimetric characteristics of intensity-modulated arc therapy( IMAT ),fixed-gantry intensity-modulated radiotherapy ( IMRT ) and 3-dimensional conformal radiotherapy (3D-CRT) for the thoracic esophageal cancer.Methods A total of 15 patients with thoracic esophageal cancer were enrolled.3D-CRT,5-field IMRT( IMRT5 ),7-field IMRT( IMRT7 ),9-field IMRT ( IMRT9 ),single arc ( Arc1 ) and double arc ( Arc2 ) RapidArc plans were generated for each patient.All plans were prescribed 40 Gy in 20 fractions and 19.6 Gy in 14 fractions to PTV at 95％ isodose line.Results RapidArc and all IMRT treatment plans in dosimetric parameters of target volumes were obviously better compared to 3-dimentional conformal treatments( t =5.77,3.52,P ＜ 0.05 ).The result of V95 of PTV for 3D-CRT,IMRT5,IMRT7,IMRT9,Arc1 and Arc2 plans was 91.55 ±2.90,96.66 ±1.05,96.87 ± 1.23,96.81 ± 1.16,94.98 ± 1.41 and 95.93 ± 1.32,respectively.The best conformation index in PTV was observed in the RapidArc plans ( t =3.76,10.01,P ＜ 0.05 ),and the best homogeneity index in PTV was observed in the IMRT plans( t =3.93,3.37,P ＜ 0.05 ).In terms of organ sparing,no statistical difference was observed between IMRT and RapidArc plans( P ＞ 0.05 ),while 3D-CRT provided the lowest number of V1 cGy and V5 cGy for total lung.Compared with the IMRT treatment plans,the number of monitor units was lower in all 3D-CRT and RapidArc cases with differences of 75％.Conclusions All the IMRT and RapidArc plans could offer high quality treatment for patients.3D-CRT might show advantage in low-dose region to organs at risk.Compared with IMRT,no obvious advantage in PTV dosimetric parameters could be observed in RapidArc plans.

Objective To compare 18 F-FDG PET/CT and electronic endoscopy for measuring the length of esophageal squamous cell carcinoma (ESCC) and to evaluate the optimal SUV threshold for contour determination of the size of the lesion.Methods Twenty-four patients (19 males and 5 females,median age:59 years) with histologically confirmed ESCC were enrolled.Three patients had stage Ⅱ,14 had stage Ⅲ and 7 had stage Ⅳ diseases.PET studies were performed before treatment.The length of ESCC was measured on FDG PET imaging using different SUV thresholds of 2.0 (L2.0),2.5 (L2.5),3.0 (L3.0),3.5 (L3.5),and 35％(L35),40％(L40),45％(L45),50％(L50),55％(L55) of SUVmax.The length of ESCC on PET imaging was compared with the length of gross tumor in vivo measured by electronic endoscopy (Lst) to determine the optimal threshold of SUV using paired t test.Pearson correlation analysis was used to assess the correlation.Results The SUVmax of primary tumor was 14.51±5.72 and the Lst was (5.27± 2.45) cm.The length was in a descending order of L2.0,L2.5,Lst,L3.0,L3.5,L35,L40,L45,L50 and L55 when using different criteria.There were significant differences between the Lst and the lengths measured on PET except those by L2.5 and L3.0((5.65±2.69) cm,(5.11±2.51) cm; t=-1.74 and 0.76,both P＞0.05).The lengths measured on PET by all criteria were significandy correlated with the Lst,respectively,with the better r values by L3.5(0.935),L2.5(0.920) and L3.0(0.919) (all P＜0.01).When SUVm~＜15,there were no significant differences between the Lst ((4.82±2.14) cm) and L2.5((4.95±2.76) cm),L3.0((4.45±2.50) cm) and L35((4.42±1.85) cm),respectively (t=-0.439,1.299,2.011,all P＞0.05).The best correlation (r=0.953,P＜0.05) was between Lst and Lz5.When SUVmax ≥ 15,there was no significant difference between Lst ((5.67±2.64) cm) and L3.0((6.11±2.61) cm; t=-0.897,P＞0.05; r=0.791,P＜ 0.05).Conclusions For better correlation of ESCC lesion size,it is suggested that the optimal threshold of SUV for contouring is 2.5 for tumor SUVmax＜15,and 3.0 for tumor SUVmax ≥ 15.A larger sampling size is needed for further confirmation or modification.

Objective To investigate the value of 18 F-fluorodeoxyglucose FDG) positron emission tomography (PET)-computed tomography (CT) in predicting the progression-free survival (PFS)and overall survival (OS) of patients with esophageal squamous cell carcinoma (ESCC) after threedimensional (3D) radiotherapy.Methods A retrospective analysis was performed on 98 ESCC patients,who underwent FDG PET-CT before 3D radiotherapy from 2004 to 2010,to investigate their 1-,3-,and 5-year PFS and OS rates.The relationship of maximum standard uptake value (SUVmax),mean SUV (SUVmean),metabolic target volume (MTV),length of primary tumor on PET-CT before radiotherapy,and number of tumors on PET with PFS and OS were analyzed.The SUVs and clinical data were analysed by independent samples t-test or Hotelling T2 test; the Kaplan-Meier method was used for calculating PFS and OS rates,and the Logrank test was used for survival difference analysis;the prognostic factors were analysed using the Cox proportional hazard model.Results The follow-up rate was 100％ ;56 patients were followed up for at least 3 years,and 27 for at 5 years.The SUVmax SUVmean and MTV of primary tumor,length of primary tumor on PET-CT before radiotherapy,and number of tumors on PET were correlated with PFS and OS (x2 =8.99-41.82,all P ＜ 0.01).The Cox regression analysis showed that PFS could be well predicted based on SUVmean (x2 =4.41,P =0.036,RR =1.398) and number of tumors on PET (x2 =6.79,P =0.009,RR =3.650) and that OS could be well predicted based on number of tumors on PET (x2 =5.03,P =0.025,RR =3.740).Conclusions When estimating the long-term response to precise radiotherapy in patients with ESCC,SUV mean and number of tumors on PET may be used to predict PFS,and number of tumors on PET may be used to predict OS.