Objective To assess the differences in delineation of organs at risk (OAR) and dosimetry between junior and senior physicians during intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) and to evaluate the role of specific training in reducing the differences.Methods Sixteen patients newly diagnosed with NPC were selected in the study.The OAR was delineated separately by three junior physicians and three senior physicians,and the geometric and dosimetric differences were assessed relative to the reference OAR.Delineation was performed again for the two OARs with the biggest difference after specific training in the two groups of physicians,and the differences were evaluated again.The difference was determined by paired t test.Results The maximum dose differences (Dmax) of OAR in the junior and senior physicians were (2.33 ± 12.06) ％ (-48.06％-137.82％) and (0.09 ± 4.72) ％ (-49.54％-42.96％),respectively (P =0.039),and the difference in the optic chiasm was the greatest ((5.85 ± 19.63) ％ ∶ (1.36 ± 4.64) ％,P =0.042).The mean dose differences (Dmean) of OAR in the junior and senior physicians were (3.10 ± 8.07)％ (-46.76％-59.76％) and (-0.93 ± 2.03) ％ (-45.54％-35.69％),respectively (P =0.021),and the difference in the parotid gland was the greatest ((13.23 ± 13.39) ％ ∶ (3.20 ± 6.71) ％,P =0.002).In the secondary delineation after training,the Dmax of the optic chiasm in the junior and senior physicians was (1.68 ± 3.34)％ and (1.50 ± 1.87) ％,respectively (P =0.841),and the difference in junior physicians was reduced significantly compared with before training ((1.68 ± 3.34) ％ ∶ (5.85 ± 19.63) ％,P =0.048) ; the Dmean of the parotid gland in the junior and senior physicians was (2.46 ± 3.06) ％ and (1.35 ± 3.00) ％,respectively (P =0.2 7 4),significantly reduced compared with before training ((2.46 ± 3.0 6) ％ ∶ (13.23 ± 13.39)％,P=0.002; (1.35 ± 3.00)％ ∶ (3.20 ± 6.71) ％,P =0.033).Conclusions The differences in delineation of OAR lead to dose uncertainties during IMRT for NPC,and specific training can improve the accuracy of delineation.

Objective To investigate the relationship between corneal basal nerve change and type 2 diabetic retinopathy based on confocal laser microscopy.Methods Together 118 patients with type 2 diabetes (T2D) were collected in our hospital from February 2016 to February 2017,including 57 patients with diabetic retinopathy (DR group) and 61 patients without DR (NDR group).For comparison,60 healthy volunteers were selected as the control group.And all the subjects were examined by corneal confocal laser microscopy to analyze the relationship between the morphological parameters of the corneal nerve and clinical variables.Results Corneal nerve fiber density,corneal nerve branch density and corneal nerve branch length in DR group were (20.03 ±4.22) · mm-2,(22.01 ± 7.05) · mm-2 and (9.50 ± 1.76) mm ·mm-2,significantly less than those of the control group and NDR group (all P ＜ 0.05);and corneal nerve fiber curvature was (0.30 ± 0.03),significantly higher than that of the control group and NDR group (all P ＜ 0.05);In DR patients,phase Ⅲ patients had smaller the corneal nerve fiber density,corneal nerve branch density and corneal nerve branch length,but the larger corneal nerve fiber curvature than the phase Ⅰ and Ⅱ patients (all P ＜ 0.05);course of disease of DR group was (12.04 ± 2.48) years,which was significantly higher than that of NDR group (P ＜ 0.05),while fasting C peptide and fasting insulin were (1.41 ± 0.58) μg · L-1 and (20.05 ± 7.91) mU · L-1,respectively,significantly lower than those of NDR group (all P ＜ 0.05);The duration of T2D was negatively correlated with the corneal nerve branch density and corneal nerve branch length (r =-0.322,-0.317,all P ＜0.05);Fasting C peptide was positively correlated with the corneal nerve branch density (r =0.298,P ＜ 0.05),and negatively correlated with the corneal nerve curvature (r =-0.311,P ＜ 0.05).Conclusion Patients with T2D retinopathy have abnormal morphology of corneal nerve.And confocal laser scanning microscopy is conducive to the early detection of microvascular disease in T2D patients with a longer course of disease or a low level of fasting C peptide.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Azithromycin ; pharmacology ; Bacteremia ; microbiology ; Child ; Child, Preschool ; Culture Media ; Drug Resistance, Bacterial ; Drug Resistance, Multiple, Bacterial ; Escherichia coli ; drug effects ; isolation & purification ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Methicillin Resistance ; Middle Aged ; Penicillin G ; pharmacology ; Salmonella paratyphi A ; drug effects ; isolation & purification ; Staphylococcus aureus ; drug effects ; isolation & purification ; Staphylococcus epidermidis ; drug effects ; isolation & purification

Objective To investigate the clinical features and management of pancreatic disease- associated portal hypertension.Methods A retrospective analysis was carried out in patients with portal hypertension complicating with pancreatic diseases in our hospital from January 1986 to April 2005. Medical records of these patients were reviewed,including data of demographics,etiologies,venous involvement,clinical presentation,laboratory tests,imaging studies,therapeutic modalities and out- comes.Results There were 59 cases of portal hypertension resulted from pancreatic diseases in our hos- pital,accounting for 4% of all portal hypertension in 19 years.The underlying pancreatic diseases were chronic pancreatitis(21 cases,35.6%),pancreatic carcinoma(20 cases,33.9%),acute pancreatitis (8 cases,13.6%),pancreatic pseudocyst(3 cases,5.1%).Of the 40 patients whose venous involve ment was identified,splenic vein obstruction occurred in 27 cases(67.5%),followed by portal vein obstruction(16 cases,40.0%).Mild or moderate splenomegaly was present in 48 cases(81.4%),with leukocytopenia as the most common manifestation of the 31 cases(52.5%)of concomitant hyper- splenism.Forty-five patients(76.3%)developed gastroesophageal varices(including 35 isolated gastric varices),among them,19 had bled(32.2%).Conservative treatment was effective in controlling acute bleeding,but could not prevent re-bleeding.Splenectomy was performed in 18 patients,mainly because of gastrointestinal hemorrhage.No postoperative bleeding occurred in the period of follow-up from 8 months to 9 years.Conclusions Pancreatic diseases may compromise portal vein and its tributaries, leading to generalized or regional portal hypertension.Pharmacological therapy can effectively control acute variceal bleeding,while surgical treatment is the appropriate procedure of choice in case of hemor- rhage recurrence.

Artemisia lactiflora is an important medicinal plant in China. The antitumor and antioxidant activities of the extracts of 54 endophytic fungi from the plant were screened via MTT assay and DPPH scavenging radical assay, respectively. The bioactive strains were identified based on similarity of 5.8S gene and internal transcribed spacer (ITS) sequences. The results showed that extracts from ten (18.5%) isolates exhibited antitumor activity, and which from two (3.7%) isolates exhibited antioxidant activity. The Alternaria sp. GYBH47 strain was simultaneously having antagonistic activity against HL-60 leukemia, MCF-7 breast and COLO205 colon cell lines, and Phomopsis sp. GYBH42 strain having cytotoxic and antioxidant activities. The results indicated that endophytic fungi from Artemisia lactiflora are potential resources to find valuable bioactive components.
Antineoplastic Agents ; chemistry ; pharmacology ; Artemisia ; microbiology ; Biphenyl Compounds ; metabolism ; Cell Line, Tumor ; Endophytes ; chemistry ; classification ; physiology ; Free Radical Scavengers ; chemistry ; pharmacology ; Fungi ; classification ; physiology ; Humans ; Picrates ; metabolism

Objective To summarize the strategies of treatment and investigate the risk factors affecting the survival of patients with hepatic cancer recurrence and metastasis after liver transplantation.Methods The clinical data of 99 patients with hepatic cancer recurrence and metastasis after liver transplantation who were admitted to the Southwest Hospital of Third Military Medical University from January 1999 to September 2011 were retrospectively analyzed.Of the 99 patients,7 patients who did not meet the criteria were excluded from the study,and 92 patients were enrolled in the study.All patients were divided into single therapy group (18 patients) and combined therapy group (74 patients).The study was reviewed by the ethics committee,and all the patients signed the informed consent form.The survival time of the 2 groups was compared,and the risk factors affecting the survival time was analyzed.All data were analyzed using the t test,chi-square test or by calculating the Fisher exact probability.The survival curve was drawn using the Kaplan-Meier method,and the survival time was compared by the Log-rank test.Factors influencing the prognosis were analyzed using the multivariate linear regression analysis.Results The survival time of patients in the single therapy group and the combined therapy group after hepatic cancer recurrence and metastasis were (5.5 ± 1.1) months and (8.5 ± 1.6) months,respectively,with a significant difference between the 2 groups (Log-rank value =7.489,P ＜ 0.05).The survival time were (7.9 ± 1.5) months for patients in TNM Ⅱ and Ⅲ A,and (7.0 ± 1.3) months for patients in TNM Ⅲ B and ⅣA,with significant difference between the 2 groups (Log-rank value =2.567,P ＜0.05).The survival time of patients with moderately or well differentiated tumors after tumor recurrence and metastasis was (8.1 ± 1.5) months,which was significantly longer than (7.2 ± 1.4)months of patients with poorly differentiated tumor (Log-rank value =2.749,P ＜ 0.05).TNM stage,tumor differentiation,Milan criteria,great vessel invasion were independent factors affecting the survival of patients with hepatic cancer recurrence and metastasis (t =2.610,3.132,4.378,2.258,P ＜ 0.05).Conclusions Combined therapy can significantly prolong the survival time of patients with hepatic cancer recurrence and metastasis.Earlier hepatic cancer recurrence and metastasis after liver transplantation result in a shorter survival time.TNM stage,tumor differentiation,great vessel invasion and Milan criteria are risk factors affecting the survival of patients with hepatic cancer recurrence and metastasis after liver transplantation.

Objective To evaluate the diagnostic value of EUS in patients with chronic abdominal pain of suspected pancreatic origin.Methods The EUS findings and related clinical data of 106 patients with chronic abdominal pain of suspected pancreatic origin(excluding the patients with suspected pancreatic malignancies)from 1991 to 2004 in PUMCH were retrospectively analyzed.Results(1)The principal dis- ease interpreting the chronic abdominal pain of suspected pancreatic origin(excluding pancreatic malignan- cies)was chronic pancreatitis(CP)(57.5%),the following contributions were other pancreatic diseases (18.9%)and unknown diseases(11.3%).(2)The sensitivity and specificity of EUS for diagnosing CP was 95.1% and 64.4% respectively,the positive predictive value(PPV)and negative predictive value (NPV)was 78.4% and 90.6% respectively.(3)Abhormalities of pancreatic parenchyma structure based on EUS were the main findings(90.2%)in patients with CP and non-homogeneous echo pattern combined with hyper echoic dots or calcification was the predominant feature(52.5%).The value of isolated inhomo- geneity and focal enhanced eehogenicity for diagnosing CP were limited(P＞0.05).Abnormalities of pan- ereatic ductal system were presented in 63.9% of patients with CP and dilation of pancreatic duct was the major feature(34.4%).CP with focal mass(inflammatory pseudotumor)was usually presented as hypo e- choic mass in the pancreatic head based on EUS(90%),which was similar to the EUS feature of pancreatic cancer.(4)The general accordant rate based on EUS with ERCP or BT-PABA were 77.8% and 70.4% re- spectively,and the correct rate based on combine diagnosis were 100% and 95.2%.Conclusion CP is the main source of chronic abdominal pain of suspected pancreatic origin(excluding pancreatic malignancies). EUS has good sensitivity but inadequate specificity for diagnosing CP,while ERCP may be more sensitive than EUS for detecting pancreatic ductal lesions.Pancreatic parenchymal abnormalities contribute the major EUS features of CP but the value of isolated inhomogeneity and focal enhanced echogenicity for diagnosing CP are limited.

Objective To make a reasonable evidence-based nursing scheme for the oxygen non-humidified of continuing nasal cannula oxygen therapy. Method Adopting the JBI clinical evidence application system, make sure the evidence baseline investigated before application, used during clinical application, and reviewed after application. Based on the now available best evidence, making examination standard and apply it to clinical care. During the application of evidence, 81 continuing low-flow (oxygen flow≤4L/min) nasal cannula oxygen patients were taken. Making assessment on the experiment group(oxygen non-humidified) and control group (oxygen humidified) in three aspects: the comfort level and effect of oxygen therapy, and humidification bottles contamination. Results During the application of evidence, the difference between experiment group and control group shows no statistical significance (P>0.05);the experiment group in oxygen therapy operating time was (162.93±40.18) s, the control group operating time was (258.60 ± 56.97) s, the difference of two groups in shows statistical significance (t=8.752, P<0.01). Conclusion The continuing low-flow (oxygen flow≤4L/min) nasal cannula oxygen therapy do not need humidification. And the clinical application of this best evidence standardizes the clinical nurses oxygen nursing behavior, reduces the nursing cost and enhances the quality of clinical nursing.

Epidemiologic Methods ; Models, Statistical

To explore the prevalence of hepatitis B virus (HBV) in multiple myeloma (MM) patients, as well as to compare the clinical characteristics and outcome between HBV infected and non-HBV infected patients. Methods:The serology markers of HBV were detected in 363 MM patients and 11227 cases of healthy controls through chemiluminescence. HBV-DNA was measured via real-time quantitative chain reaction. Results:Sixteen out of 363 MM patients (4.4%) were HBsAg-positive, showing significant difference with healthy controls (2.4%). No statistically significant differences were observed in terms of sex, age, type of monoclonal (M) protein, International Staging System (ISS) stage, stem cell transplantation, and risk stratification between HBsAg-positive and HBsAg-negative patients. No significant effect of HBV infection was found on the OS of MM patients. HBV reactivation was observed in two HBsAg-positive MM patients who were treated with combination chemotherapy, including bortezomib and dexamethasone. The replication of HBV could be inhibited by anti-HBV drugs. Conclusion:A higher prevalence of HBV infection was revealed in MM patients. Close monitoring of HBV replication should be conducted in MM patients with HBV infection before and during the courses of chemotherapy.