Objective To evaluate the accuracy of air column width difference (ACWD) between inflation and deflation of the cuff of the endotracheal tube (ETT) in predicting post-extubation stridor (PES).Methods A total of 102 intubated patients of both sexes and all ages,who were mechanically ventilated for ≥24 h in the intensive care unit,of American Society of Anesthesiologists physical status Ⅲ or Ⅳ,were enrolled in the study.After the patients were in a stable condition and recovered consciousness and myodynamia,they were weaned from the ventilator,and ultrasound examination of the larynx was performed to determine ACWD between ETT cuff inflation and deflation.PES was assessed using blinding nethod after extubation,and the patients were divided into 2 groups depending on whether or not the patients developed PES:PES group (group P) and non-PES group (group N).Results There were 94 patients in group N and 8 patients in group P.Compared with group N,ACWD was significantly decreased in group P (P＜ 0.05).The cut-off value of ACWD determined by the receiver operating characteristic curve was 1.65 mm,the sensitivity and specificity of ACWD were 0.830 and 0.750,respectively,and the area under the receiver operating characteristic curve was 0.801.Conclusion For the intubated patients who are mechanically ventilated for ≥24 h in an intensive care unit,ACWD between ETT cuff inflation and deflation＜ 1.65 mm can effectively predict PES.

The disability and mortality of acute ischemic stroke are very high,which brings great burden to family and society.Timely and effective vascular recanalization is possible to make a good prognosis for patients.Since 2008,the intravenous thrombolytic therapy for patients with acute ischemic stroke within the time window has become the recommended treatment scheme of the guidelines in different countries.However,intravenous thrombolysis has the disadvantages of low vascular recanalization rate,narrow treatment time window,and relatively more contraindications,which limits its clinical application.In recent years,with the appearance of stent-like thrombectomy devices,mechanical thrombectomy within the time window has gradually become the mainstream treatment scheme for acute ischemic stroke.The latest guidelines for stroke treatment recommend the use of intravenous thrombolytic bridging endovascular thrombectomy within the time window.However,it is still unclear whether intravenous thrombolysis will increase the rate of vascular recanalization,improve clinical outcome,and increase the risk of intracranial hemorrhage before thrombectomy.This article reviews the vascular recanalization rate,clinical outcome,and intracranial hemorrhage risk of bridging therapy and direct mechanical thrombectomy.

Objective To investigate the disease-causing mutation in a family with Leber congenital amaurosis (LCA).Methods A Chinese Han pedigree with LCA from Chaoshan area was recruited in Shantou International Eye Center in August 2011.The clinical features of the families were evaluated,including medical history,best corrected visual acuity,intraocular pressure and fundus photography.The peripheral blood sample of 5 ml was collected from each of the family members for the extraction of genomic DNA.DNA of the proband was investigated by whole exome sequencing (WES) and was filtered for function of variants and inheritance pattern.Then,Sanger sequencing was performed to confirm the WES result on all the participating subjects in the pedigree.Results There were 11 families of 3 generations in this pedigree,and 2 female LCA patients were found (Ⅱ 2 and Ⅱ4) who were sisters.The parents (Ⅰ-1 and Ⅰ-2) and children (Ⅲ-1,Ⅲ-2,Ⅲ-3 and Ⅲ-4) of the patients showed normal phenotype,suggesting an autosomal recessive pattern.The patients appeared severe visual impairment during early childhood.Ophthalmic examination showed diffuse pigmentation on the retina and attenuation of retinal artery in both patients.WES of proband revealed two compound heterozygous mutations (c.2234C ＞T,p.T745M;c.3488G＞T,p.C1163F) of the CRB1 gene.Sanger sequencing confirmed the mutations in both patients (Ⅱ-2 and Ⅲ-4),and the parents of the patients were found to carry one mutations respectively and the other subjects with normal phenotype had neither none or only one mutation.Conclusions The compound heterozygous mutation of c.2234C＞ T,p.T745M and c.3488G＞T,p.C1163F in CRB1 is responsible for LCA pathogenesis this Chinese Han pedigree.

Objective To investigate the optimal gamma passing rate of intensity-modulated radiotherapy (IMRT) dosimetric verification in the treatment of esophageal cancer using a three-dimensional dose verification system EDoseTM.Methods Twenty five esophageal cancer patients treated by 7-field IMRT were retrospectively reviewed.Measured dose distribution were reconstructed on CT image and evaluated by gamma analysis and DVH metrics using the EDoseTM system.Plans with DVH metrics dose difference ＜ 5％ or with gamma passing ＞ 90％ under 3％/3 mm criteria were accepted.The optimal gamma passing rate for criteria of 5％/3 mm,3％/3 mm,2％/2 mm were investigated by drawing the receiver operating characteristic (ROC) curves and calculating the Youden Index.The sensitivity and specificity of the these optimal thresholds in the plan verification were also analyzed.Results The optimal thresholds for global gamma indices with 5％/3 mm,3％/3 mm,2％/2 mm were 98.66％,94.84％,78.56％,respectively.In the 90％ common threshold,The sensitivity and specificity for common 90％ threshold and optimal threshold under 3％/3 mm criteria were 0.17 vs.0.85 and t 0.84 vs.0.27,respectively.The sensitivity and specificity were 0.89,0.65 and 0.23,0.47 for optimal thresholds under 5％/3 mm and 2％/2 mm criteria,respectively.Conclusions The sensitivity of optimal threshold gamma passing rate improved significantly compared with the common threshold (90％) at 3％/3 mm criteria.,The sensitivity and the specificity were more balanced at the 2％/2 mm criteria compared with those at 3％/3 mm criteria.

Objective To investigate the optimal thresholds of the passing rate with different gamma measurement criteria (percent dose difference/DTA) based on the Delta 4 three-dimensional dosimetric verification system in the verification of volumetric modulated arc-therapy (VMAT) plan for cervical cancer.Methods Thirty clinically-approved dual-arc VMAT plans using the RapidArcTM (Varian Medical Systems Inc.) for cervical cancer were randomly selected.The gamma analysis and dose-volume histogram (DVH) evaluation were performed using Delta 4.All the plans were classified according to the following two criteria:1.If the absolute percentage dose errors of all specific dosimetry indices on the DVH were less than 5％,the plan was regarded as clinically acceptable.2.If the gamma passing rate was 90％ or 95％ under the criteria of 2％/2 mm and 3％/3 mm,the plan was regarded as acceptable.The sensitivity and specificity analyses were conducted based on the classification results and the receiver operating characteristic (ROC) curve was plotted.By calculating the Youden Index,the optimal thresholds under different Gamma criteria (global and local 2％/2 mm and 3％/3 mm) were investigated.Finally,the ability of distinguishing the plan was clinically acceptable or not between the conventional and optimal thresholds was quantitatively compared according to the sensitivity and specificity analyses.Results The optimal thresholds under the global 3％/3 mm and 2％/2 mm criteria were 98.3％ and 87.05％;and 97.55％ 、86.05％ for the local gamma analysis.Compared with the conventional thresholds,the sensitivity of the optimal thresholds was 0.93 by using the global and local gamma analyses under the 3％/3 mm criterion.Under the 2％/2 mm criterion,the sensitivity of the optimal thresholds was 0.65 and the specificity was 0.49 by using the global gamma analysis.The sensitivity was 0.7 and the specificity was 0.46 by using the local gamma analysis,suggesting that the sensitivity and the specificity were more balanced under the 2％/2 mm criterion.Conclusions Application of the optimal thresholds in the verification of VMAT plans can maintain the balance between the sensitivity and specificity,prevent the harm of clinically unacceptable plans to patients to certain extent and reduce the probability of increasing the daily work load for physicists due to the misjudgement of clinically acceptable plans.

Objective:To develop the screening checklist of brief interview for autism disorder suitable for Chinese children and evaluate its reliability and validity.Methods:Based on existed research results and diagnostic criteria for autism spectrum disorder of DSM-5, the screening checklist of brief interview for autism spectrum disorder(SCAD) was developed. A sample of 238 children were selected for investigation and 28 of them were retested for test-retest reliability with 2-4 weeks interval. Cronbach's α coefficient, split-half correlation coefficient, test-retest reliability, and evaluator consistency were used to test the reliability of the scale. Content validity, construct validity and empirical validity were used to test the validity of the scale.All statistical analysis were conducted by SPSS 22.0 and AMOS 17.0.Results:The SCAD contains two components and six dimensions, with a total of 25 items. The Cronbach's α coefficient was 0.936 for the total scale and were 0.938, 0.771 for the two components. The split-half coefficient for the total scale and the two components were 0.962, 0.938 and 0.794. The test-retest reliability for the total scale and the two components were 0.806, 0.795 and 0.766. The Kendall coefficient for the total scale and the two components were 0.968, 0.982 and 0.950. The SCAD item-level content validity index (I-CVI) ranged from 0.66 to 0.98 and the Kappa value ranged from 0.66 to 0.98. The scale-level content validity S-CVI/UA and S-CVI/Ave were 0.89 and 0.94. The correlations between SCAD and calibration tests such as ABC, CARS and M-CHAT were 0.54, 0.53 and 0.87, and the correlation coefficients with the M-CHAT-R/F between the two components were 0.87 and 0.76 respectively (both P<0.01). The result of CFA demonstrated that the model fitted the data with well construct validity(χ 2/ df=0.910, RMR=0.049, AGFI=0.974, RMSEA=0.010, PNFI=0.530, PCFI=0.533, NFI=0.994, RFI=0.988, CFI=1.000). The correlation coefficient of the two components was 0.88 and that with the total scale were 0.97 and 0.90, each dimensions with the total scale ranged from 0.72 to 0.93. Conclusion:The SCAD has a good reliability and validity, and it can be used as a clinical screening tool for children with autism spectrum disorder.

Objective:To establish a metaheuristics-based automatic radiotherapy treatment planning method (ATP-STAR) and verify its effectiveness.Methods:The main process of the ATP-STAR method was as follows. First, the optimization parameters were vectorized for encoding and corrected using Gaussian convolution. Then, the candidate optimization parameter vector set was selected through simulated annealing. Finally, the optimal combination of optimization parameters was determined by combining the field fluence optimization to achieve automatic trial-and-error. Twenty cases with large individual differences in tumors were selected for testing. Clinical physicists with more than five years of experience were invited to perform manual planning. Both the manual and ATP-STAR plans were made utilizing the matRad open source software for radiation treatment planning, with the fields and prescribed doses consistent with those of the clinical treatment plans. The dosimetric differences of target volumes and organs at risk between the ATP-STAR and manual plans for different diseases were analyzed.Results:For the target volumes, the ATP-STAR plans showed superior homogeneity compared with the manual plans (brain tumors: z = 2.28, P = 0.022; lung cancers: z = 2.29, P = 0.022; liver cancers: z = 2.11, P = 0.035). The conformability of the ATP-STAR plans was comparable to that of the manual plans for brain tumors and liver cancer and was slightly lower than that of the manual plans for lung cancer ( z = 2.29, P = 0.022). The comparison result of doses to organs at risk (OARs) between the manual plans and STAR plans were as follows. For OARs of brain tumors, the ATP-STAR plans decreased the mean left lens Dmean from 2.19 Gy to 1.76 Gy ( z = 2.28, P = 0.022), decreased left optic nerve Dmean from 11.36 Gy to 10.22 Gy ( z = 2.28, P = 0.022), decreased right optic nerve Dmax from 32.92 Gy to 29.97 Gy ( z = 2.10, P = 0.036), and decreased pituitary Dmax from 39.53 Gy to 35.21 Gy ( z = 2.29, P = 0.022). For OARs of lung cancer, the ATP-STAR plans decreased the mean spinal cord Dmax from 38.00 Gy to 31.17 Gy ( z = 2.12, P = 0.034), decreased the bilateral lungs Dmean from 8.51 Gy to 8.07 Gy ( z = 2.29, P = 0.022), and decreased cardiac Dmean from 3.21 Gy to 2.69 Gy ( z =2.29, P = 0.022). For OARs of liver cancer, the ATP-STAR plans decreased spinal cord Dmax from 18.19 Gy to 14.76 Gy ( z = 2.11, P = 0.035), decreased liver Dmean from 15.61 Gy to 14.45 Gy ( z = 2.11, P = 0.035), and decreased kidneys Dmean from 4.76 Gy to 4.04 Gy ( z = 2.10, P = 0.036). Conclusions:The proposed ATP-STAR method relies little on the experience of manual planning and thus is easy to be widely applied. This method is expected to improve the quality and consistency of IMRT plans and save clinical labor and time costs.

Objective:To investigate the effects of off-target isocenter plans with different off-target distances on the plan quality and delivery accuracy of stereotactic body radiotherapy (SBRT) for lung cancer, aiming to provide a reference for the clinical plan design of SBRT for lung cancer.Methods:For 10 lung cancer patients treated with SBRT, isocenter reference plans were designed by setting the plan isocenters at the mass centers of tumors and 60 off-target isocenter plans by setting the isocenters at distances of 1, 3, 5, 8, and 10 cm from the mass centers of tumors. The dosimetric differences between the off-target isocenter plans and the reference plans. Subsequently was analyzed, under different positional errors (0-5 mm). The gamma pass rates (GPRs) of these plans were measured using the Octavius 4D high-resolution dose verification system, and 240 verifications of these plans were completed. The robustness of the delivery accuracy of the reference plans and off-target isocenter plans were analyzed under different positional errors.Results:The off-target isocenter plans yielded slightly worse dose gradient indices than the isocenter reference plans, but there was no statistically significant differences. With an increase in the off-target distance, the mean lung dose (MLD), V20 of normal lungs, as well as the Dmax of bronchi, showed slight upward trends. Compared with the isocenter reference plans, the MLD of the off-target isocenter plans increased by 0.8%, 0.8%, and 1.9% at off-target distances of 1, 3, and 10 cm, respectively, with statistically significant differences ( z = -2.34 to -1.99, P < 0.05), and the V20 of the off-target isocenter plans increased by 2.0%, 2.5%, and 3.7% at off-target distances of 1, 5, and 10 cm, respectively, with statistically significant differences ( z =-2.11 to -1.99, P < 0.05). In the case of a positional error of up to 5 mm, the GPRs of plans with off-target distances of 5 cm and above decreased by more than 1.0% on average and up to a maximum of 3.5%, showing statistically significant differences ( z = 2.13-2.75, P < 0.05). Conclusions:Compared to the reference plans, the off-target isocenter plans showed slightly lower dosimetric quality and less robust delivery accuracy under different positional errors. Therefore, it is necessary to avoid the plans and treatment with too large off-target distances (≥ 5 cm) as far as possible for SBRT of lung cancer.

Resveratrol (RES), a natural polyphenolic phytochemical, has been suggested as a putative anti-aging molecule for the prevention and treatment of Alzheimer's disease (AD) by the activation of sirtuin 1 (Sirt1/Sir2). In this study, we tested the effects of RES and Sirt1/Sir2 on sleep and courtship memory in a Drosophila model by overexpression of amyloid precursor protein (APP), whose duplications and mutations cause familial AD. We found a mild but significant transcriptional increase of Drosophila Sir2 (dSir2) by RES supplementation for up to 17 days in APP flies, but not for 7 days. RES and dSir2 almost completely reversed the sleep and memory deficits in APP flies. We further demonstrated that dSir2 acts as a sleep promotor in Drosophila neurons. Interestingly, RES increased sleep in the absence of dSir2 in dSir2-null mutants, and RES further enhanced sleep when dSir2 was either overexpressed or knocked down in APP flies. Finally, we showed that Aβ aggregates in APP flies were reduced by RES and dSir2, probably via inhibiting Drosophila β-secretase (dBACE). Our data suggest that RES rescues the APP-induced behavioral deficits and Aβ burden largely, but not exclusively, via dSir2.
Animals ; Alzheimer Disease/metabolism* ; Amyloid beta-Peptides ; Amyloid beta-Protein Precursor/metabolism* ; Drosophila/physiology* ; Drosophila Proteins/metabolism* ; Resveratrol/pharmacology* ; Sirtuin 1 ; Sleep