Objective:To evaluate the effect of reducing clinical target volume (CTV) on local control and overall survival in postoperative intensity-modulated radiotherapy (IMRT), and analyze the patterns of failure, aiming to provide clinical basis for postoperative IMRT delineation of CTV for parotid gland cancer in the era of precision radiotherapy.Methods:Clinical data of 126 patients who were pathologically diagnosed with parotid gland cancer and treated with parotidectomy as well as postoperative radiotherapy were retrospectively analyzed. All patients were divided into two groups according to the prozone of CTV. It was delineated to the anterior border of parotid gland in group A, and delineated to the anterior border of masseter in group B. Actuarial estimates of local recurrence-free survival, regional recurrence-free survival, distant metastasis-free survival and overall survival were obtained with the Kaplan-Meier method. Univariate prognostic analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by Cox regression model.Results:The 5-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS) and overall survival (OS) in groups A and B were 96.7% vs. 91.3%, 96.7% vs. 90.2%, 86.9% v s. 81.3% and 86.0% vs. 81.4%, respectively. There were no significant differences in these parameters between two groups. Of 126 patients with parotid carcinoma, 7 had local recurrence. There were 2 cases in group A which 1 recurred in-field and 1 recurred out- field. And there were 5 cases in group B which 4 recurred in-field and 1 recurred marginally. Univariate analysis showed that age was associated with LRFS. Age, N stage and pathological grading were associated with OS. Cox multivariate analysis revealed that age, N stage and pathological grading were the independent influencing factors of OS. Conclusions:Reducing the CTV would not increase the risk of local recurrence in patients with parotid gland carcinoma without tumor extravasation and negative surgical margins. There is no significant difference in survival benefit compared to those delineated to the anterior border of the masseter muscle. The delineation of CTV should be treated differently according to the risk factors.

Rituximab is currently used as a first-line therapy for phospholipase A 2 receptor-associated membranous nephropathy due to its good efficacy and safety. Although the remission rate after rituximab treatment is more than 60%, nearly 40% patients still do not respond to treatment. We used obinutuzumab to treat 3 cases of rituximab resistant PLA 2R-associated membranous nephropathy. After the first dose of 1 000 mg with or without additional dose, the amount of anti-PLA 2R antibody and urinary protein decreased significantly and the adverse reactions were mild. The results show that obinutuzumab has a certain therapeutic effect on rituximab resistant PLA 2R-associated membranous nephropathy, but the time of follow-up observation is short and can only be used as individual cases, which needs to be confirmed by a large sample and high-quality prospective cohort study.

Objective:To investigate the clinical value of changes in peripheral NKT cells and tumor abnormal proteins (TAPs) in stage Ⅲ-Ⅳ B head and neck squamous cell carcinoma (HNSCC) before and after radiotherapy. Methods:A retrospective analysis was performed using the data of 101 HNSCC patients, who were confirmed from January 2019 to December 2021 and treated with radical and postoperative radiotherapy. Flow cytometry and the agglutination method were used to determine the proportion of NKT cells in peripheral blood and the TAP coagulation area, respectively before and after radiotherapy. The relationships of clinical features and the cellular features such as changes in NKT cells and ATPs with local recurrence and long-term survival were analyzed. The χ2 test or Fisher′s exact test was employed for intergroup comparison. The Kaplan-Meier method and the Cox model were utilized for univariate and multivariate survival prognosis analyses, respectively. The bivariate Pearson linear correlation analysis was conducted to analyze the relationship between NKT and TAP. Results:The median follow-up time of the whole group was 25 months. Regarding the 1-, 2-, and 3-year survival rates, the local-regional recurrence-free survival (LRRFS) rates were 76.2%, 67.3%, and 64.4%, respectively, the distant metastasis-free survival (DMFS) rates 91.1%, 90.1%, and 89.1%, respectively, and the progression-free survival (PFS) rates 69.3%, 59.4%, and 55.4%, respectively. The 3-year overall survival (OS) rate was influenced by age, surgery, N stage, TNM stage, NKT cell ratio, and TAP, while the 3-year PFS rate was affected by TAP, sex, N stage, and TNM stage. Multivariate analysis suggests that independent adverse prognostic factors for HNSCC included sex, age, N stage, NKT cells, and TAP ( HR=3.00, 2.35, 2.27, 2.02, 2.56, P<0.05). The correlation analysis indicates a positive correlation between NKT cells and TAP ( r=0.26, P=0.009). Conclusions:Stage Ⅲ-Ⅳ B HNSCC treated with radical and postoperative radiotherapy is subjected to a high recurrence rate. Further research is required for the expression levels of NKT cells and TAP in peripheral blood, as well as the influence of their changes during radiotherapy on the 3-year OS, PFS, and LRRFS rates of locally advanced HNSCC.

Objective:To analyse the pathogenic bacteria distribution and clinical characteristics of late-onset sepsis (LOS) among premature infants with gestational age less than 34 weeks in Henan Province.Methods:The clinical data of 6 590 premature infants admitted to 17 medical institutions in Henan Province from January 2019 to December 2020 were retrospectively analyzed. The gestational age of infants was less than 34 weeks and was admitted to the neonatal ward within 7 days after birth. SPSS 19.0 statistical software was used for data analysis.Results:Among 6 590 premature infants LOS developed in 751 cases (11.40%), of whom the diagnosis was confirmed in 276 cases (36.75%) and 475 cases (63.25%) were diagnosed clinically. The fatality rate related to LOS was 13.58%. There were significant differences in the incidence of LOS and infection-related mortality among infants with different gestational ages and body weights ( χ2=388.894 and 13.572, χ2=472.282 and 9.257, P<0.05 or <0.01). Among 276 children with confirmed LOS, 286 strains of pathogenic bacteria were isolated. Gram-negative bacteria were most prevalent (178 strains), accounting for 62.24% of all infections, followed by fungi (58 strains, 20.28%). Klebsiella pneumoniae was most frequently detected Gram-negative bacteria (117 strains, 40.91%), among which 32.48% (38/117) was carbapenem-resistant Klebsiella pneumoniae. The proportion of diagnosed sepsis, the proportion of catheterization, and the infection-related mortality of infants with LOS in tertiary hospitals were all higher than those in secondary hospitals ( χ2=6.212, 5.313 and 4.435, all P<0.05). The proportion of exclusive breastfeeding in secondary hospitals was lower than that in tertiary hospitals ( χ2=19.216, P<0.05). The time of antibacterial drug use before infection in specialized hospitals was longer than that in general hospitals ( χ2=3.276, P<0.05). Conclusion:The incidence of LOS among preterm infants in Henan Province is high, which was mainly caused by Gram-negative bacteria. The clinical characteristics of LOS caused by different pathogens and in different health institutions are different, the prevention and control strategy should be developed accordingly to reduce the incidence LOS of preterm premature infants.

Epidemiological studies have shown that exposure to tobacco smoke causing irritation and inflammation in the airways tends to reduce serum periostin concentrations in adults. We now investigate prospective cross-sectional study on 135 Korean students aged 7 years in the first grade who were participating in the Seongnam Atopy Project for Children's Happiness 2016 (SAP2016) cohort. To the best of our knowledge, this is the first study to show significant inverse correlations between serum periostin concentration and exposure to xylene and formaldehyde in children. Our findings suggested the need for caution in using the serum periostin level as a marker for allergic diseases, since exposure to volatile organic compounds and formaldehyde may confound the interpretation of these results.
Adult ; Child* ; Cohort Studies ; Cross-Sectional Studies ; Epidemiologic Studies ; Formaldehyde* ; Gyeonggi-do ; Happiness ; Humans ; Inflammation ; Prospective Studies ; Smoke ; Tobacco ; Volatile Organic Compounds* ; Xylenes