Objective To evaluate the feasibility of applying spectral CT material suppressed iodine (MSI) imaging as virtual plain CT scan to replace traditional non-contrast (TNC) CT in head and neck neoplasms. Methods A total of 52 patients with initial diagnosis of head and neck neoplasms underwent TNC CT scanning and spectrum mode enhanced scanning in the head and neck with spectral CT. With GSI Volume Viewer software from GE AW4.6 workstation, the enhanced scanning data were processed and MSI images were acquired. The CT values of different tissues (fat, erector spinae, cervical vertebrae, thyroid, and brain parenchyma) and the enhancement rate in erector spinae, carotid sinus were compared between MSI and TNC images. Image quality was objectively evaluated in noise and SNR for MSI and TNC images, while the subjective evaluation included the visibility of lesions, subjective acceptance rate, diagnostic efficacy (with/without lesions or lesion calcification, necrosis). Radiation dose including volume CT dose index (CTDIvol) and effective dose (ED) was compared between MSI and TNC. Results (1) CT values of erector spinae on MSI and TNC imaging were(52 ± 6)and(52 ± 7)HU respectively, and the difference between the two image modes was not significant(t=0.39,P>0.05). CT values on MSI and TNC Imaging were[-74 (-86,-59)HU]and[-79(-73,-61)HU]for fat (Z=-2.71, P<0.05),[139(121,196)HU]and[282 (237,336) HU,Z=-5.46]for vertebrae (Z=-5.46, P<0.05),[57(48,61)HU]and[96(74,110) HU]for thyroid (Z=-4.85, P<0.05),[35(32,39)HU]and[35(32,39)HU]for brain parenchyma (Z=-4.74, P<0.05) respectively. (2) There was no significant difference in enhancement rate of erector spinae between MSI and TNC imaging 1.15(1.07,1.20) and 1.14(1.03,1.26) respectively, Z=-5.50, P>0.05). The difference of carotid sinus enhancement rate was significant 5.75(4.70,6.73) and 4.37(3.91,5.61) respectively, Z=-5.50, P<0.05). (3) The noise of MSI[10.61(8.34,13.57) HU)]was higher than that of TNC [9.32(7.40,11.42) HU](Z=-2.52,P<0.05), and the SNR of MSI [-6.59(-8.59—-4.25)] was lower than that of TNC[-7.94(-10.25,-5.51)] (Z=-2.73,P<0.05). (4) Median scores of subjective imaging quality evaluation were 4(3.00,4.75) and 4(3.00,4.00) in MSI and TNC images respectively, and the difference was not significant(Z=-0.45,P>0.05).Unacceptable and acceptable cases in imaging quality of MSI were 3 and 49 respectively, while those were 2 and 50 in TNC group. Subjective acceptance rate between MST and TNC images was not significantly different(?2=0.01,P>0.05). (5) Diagnostic performance evaluation showed that the consistency of two observers was good in detecting lesions, necrosis and calcification between MSI and TNC image, with K value 0.93, 0.83 and 0.90 respectively (P<0.05). (6) Radiation doses between pure energy spectrum enhanced mode and conventional pre plus post contrast enhanced mode were compared. And differences of CTDIvol[11.78(10.98,17.30) mGy]and[23.89 (22.42, 29.98) mGy] respectively],ED [1.89(1.63,2.29) mSv]and[3.77(3.21,4.16 ) mSv] respectively] were significant(Z=-6.28, P<0.05). Pure energy spectrum enhanced mode reduced 39.07% of CTDIvol and 45.75%of ED respectively. Conclusions MSI imaging can be a potential substitute for TNC imaging. And it has clinical values in the diagnosis of head and neck neoplasms.

OBJECTIVETo explore efficacy and safety of modified FOLFIRINOX (mFOLFIRINOX) regimen by dose attenuation in locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer(MPC).

METHODSBetween April 2014 and October 2015, 35 patients with LAPC (n=18) or MPC (n=17) were treated with mFOLFIRINOX regimen (irinotecan 135 mg/m(2), oxaliplatin 68 mg/m(2), 5-FU 2 400 mg/m(2), no bolus of 5-FU, leucovorin 400 mg/m(2)) in the Second Affiliated Hospital of Zhejiang University School of Medicine. The primary end point was progression free survival. The second end points were overall survival, objective response rate, adverse effects, surgical resection rate for LAPC.

RESULTSAmong 35 patients, 6 patients (17.1%) who dropped out and received less than 2 cycles were excluded for response analysis. Among the other 29 patients, 9 patients had grade 3 or 4 adverse effects. No patients ceased treatment due to adverse effects. The 29 patients received 5 (2-13) cycles were evaluated by efficacy and found partial remission in 16 cases, stable disease in 10 cases, progression disease in 3 cases. Response rate was 55.2%. Nine patients with LAPC accomplished surgery after neoadjuvant treatment without perioperative complication and death, and 6 patients accepted R0 resection.

CONCLUSIONSThe mFOLFIRINOX regimen used in the study is well-tolerated in Chinese population with high treatment efficacy on patients with LAPC and MPC. Further investigation of efficacy and adverse effects on more advanced pancreatic cancer patients is necessary.

Antineoplastic Combined Chemotherapy Protocols ; Camptothecin ; administration & dosage ; analogs & derivatives ; Disease Progression ; Disease-Free Survival ; Fluorouracil ; administration & dosage ; Humans ; Leucovorin ; administration & dosage ; Neoadjuvant Therapy ; Organoplatinum Compounds ; administration & dosage ; Pancreatic Neoplasms ; drug therapy ; Tertiary Care Centers ; Treatment Outcome

Objective To retrospectively analyze the distribution and drug resistance of pathogenic bacteria in urinary tract infection in Xiangyang Central Hospital from 2017-2019, so as to provide a basis for clinical treatment of urinary tract infection and rational use of antibiotics. Methods The pathogenic bacteria isolated from clinical urine culture in Xiangyang Central Hospital from January 2017 to December 2019 were collected, and BD Phoenix^TM 100 was used for the identification of pathogens and antimicrobial sensitivity test. The WHONET 5.6 and GraphPad Prism 5.0 software were used for data analysis. Results A total of 3 056 strains of pathogens were isolated from 15 672 urine specimens (19.50%). Gram-negative bacteria accounted for 77.95%, of which E. coli was the most common (52.45%). Gram-positive bacteria accounted for 12.63%, including E. faecalis (4.80%) and E. faecium (4.80%). Fungi accounted for 9.50%. The clinical departments with the highest rates of urinary culture submission and positive detection were Urology (26.20%) and Endocrinology (41.90%), respectively. E. coli and K. pneumoniae had high resistance rates to piperacillin, compound trimethoprim, cefuroxime, ceftriaxone and cefazolin, all exceeding 50.00%, while P. aeruginosa was relatively sensitive to various antibiotics. The resistance rates of these three gram-negative bacteria to carbapenem antibiotics increased year by year. The isolated gram-positive cocci were mainly enterococcus faecalis and enterococcus faecalis. They were highly sensitive to linazolamide, vancomycin and teicoplanin, but the resistance rates to other types of antibiotics were quite different. The average detection rates of ESBLs-producing E. coli and K. pneumoniae were 52.90% and 59.00%, respectively. Conclusion The pathogens of urinary tract infections in Xiangyang Central Hospital from 2017 to 2019 are mainly gram-negative bacteria, and the resistance rate to carbapenem drugs is increasing year by year. The ESBLs-producing strains of E. coli and K. pneumoniae are highon should be strengthened in patients with high DOB value and smoking.

Simulations can mimic the environment that refers to the surgery operation to improve the technical skills of the trainees. In this paper, we designed a new cardiac surgery simulative training system. The isolated pig heart was selected as the heart model. A mechanical device was designed to achieve the beating of heart model. At the same time, adjusting frequencies of mechanical movement could change the rating of heartbeat. In order to validate the rationality of the system, 12 non-medical specialty students and 12 medical specialty students were divided into two groups, which consecutively accepted seven-days of training for off-pump coronary artery bypass grafting using the cardiac surgery simulative training system. The time for completing bypass grafting before and after training were recorded. And the bridging outcomes of each trainee were assessed by 3 surgery cardiac surgeons using the object structured assessments of technical skill (OSATS) criteria. After training, each trainee could finish the bypass suturing in a shorter time than before training, and the scores of each trainee assessed by OSATS criteria were also improved. The results showed that the cardiac surgery simulative training system had better training effect in improving the surgical techniques, operation skills and proficiency of surgical instruments of trainees.

BACKGROUND: The relationship between quality of life at three months after lung cancer surgery and different surgical approaches is remains unclear. This study aimed to compare the quality of life of patients three months after uniportal and multiportal thoracoscopic lobectomy. METHODS: Data from patients who underwent lung surgery at the Department of Thoracic Surgery, Sichuan Cancer Hospital between April 2021 and October 2021 were collected. The European Organization for Research and Treatment of Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and Quality of Life Questionnaire-Lung Cancer 29 (EORTC QLQ-LC29) were used to collect quality of life data of the patients. Potential confounding factors in the baseline data were included in a multivariate regression model for adjustment, and the quality of life of the two groups three months postoperatively was compared with traditional clinical outcomes. RESULTS: A total of 130 lung cancer patients were included, with 57 males (43.8%) and 73 females (56.2%), and an average age of (57.1±9.5) yr. In the baseline data of the two groups, there was a statistical difference in the number of chest drainage tubes placed (P<0.001). After adjustment with the regression model, at three months postoperatively, there were no significant differences in all symptoms and functional status scores between the two groups (all P>0.05). The multiportal group had longer surgery time (120.0 min vs 85.0 min, P=0.001), postoperative hospital stay (6.0 d vs 4.0 d, P=0.020), and a higher incidence of early ≥ grade 2 complications (39.0% vs 10.1%, P=0.011) compared to the uniportal group. CONCLUSIONS Patients undergoing uniportal and multiportal thoracoscopic lobectomy have similar quality of life at three months postoperatively. The uniportal group may have certain advantages in terms of traditional clinical outcome indicators such as operation time, postoperative hospital stay, and early postoperative complications.
Male ; Female ; Humans ; Lung Neoplasms/surgery* ; Quality of Life ; Thoracic Surgery, Video-Assisted/adverse effects* ; Pneumonectomy/adverse effects* ; Postoperative Complications/surgery* ; Retrospective Studies