Objective: To develop a predictive model for pathologic complete response (pCR) of ipsilateral supraclavicular lymph nodes (ISLN) after neoadjuvant chemotherapy for breast cancer and guide the local treatment. Methods: Two hundred and eleven consecutive breast cancer patients with first diagnosis of ipsilateral supraclavicular lymph node metastasis who underwent ipsilateral supraclavicular lymph node dissection and treated in the Breast Department of Henan Cancer Hospital from September 2012 to May 2019 were included. One hundred and forty two cases were divided into the training set while other 69 cases into the validation set. The factors affecting ipsilateral supraclavicular lymph node pCR (ispCR)of breast cancer after neoadjuvant chemotherapy were analyzed by univariate and multivariate logistic regression analyses, and a nomogram prediction model of ispCR was established. Internal and external validation evaluation of the nomogram prediction model were conducted by receiver operating characteristic (ROC) curve analysis and plotting calibration curves. Results: Univariate logistic regression analysis showed that Ki-67 index, number of axillary lymph node metastases, breast pCR, axillary pCR, and ISLN size after neoadjuvant chemotherapy were associated with ispCR of breast cancerafter neoadjuvant chemotherapy (P<0.05). Multivariate logistic regression analysis showed that the number of axillary lymph node metastases (OR=5.035, 95%CI: 1.722-14.721, P=0.003), breast pCR (OR=4.662, 95%CI: 1.456-14.922, P=0.010) and ISLN size after neoadjuvant chemotherapy (OR=4.231, 95%CI: 1.194-14.985, P=0.025) were independent predictors of ispCR of breast cancer after neoadjuvant chemotherapy. A nomogram prediction model of ispCR of breast cancer after neoadjuvant chemotherapy was constructed using five factors: number of axillary lymph node metastases, Ki-67 index, breast pCR, axillary pCR and size of ISLN after neoadjuvant chemotherapy. The areas under the ROC curve for the nomogram prediction model in the training and validation sets were 0.855 and 0.838, respectively, and the difference was not statistically significant (P=0.755). The 3-year disease-free survival rates of patients in the ispCR and non-ispCR groups after neoadjuvant chemotherapy were 64.3% and 54.8%, respectively, with statistically significant differences (P=0.024), the 3-year overall survival rates were 83.8% and 70.2%, respectively, without statistically significant difference (P=0.087). Conclusions: Disease free survival is significantly improved in breast cancer patients with ispCR after neoadjuvant chemotherapy. The constructed nomogram prediction model of ispCR of breast cancer patients after neoadjuvant chemotherapy is well fitted. Application of this prediction model can assist the development of local management strategies for the ipsilateral supraclavicular region after neoadjuvant chemotherapy and predict the long-term prognosis of breast cancer patients.
Axilla/pathology* ; Breast Neoplasms/pathology* ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes/pathology* ; Lymphatic Metastasis/pathology* ; Neoadjuvant Therapy ; Nomograms ; Retrospective Studies

Breast Neoplasms/surgery* ; China ; Humans ; Mastectomy ; Mastectomy, Modified Radical

Asians ; Biological Assay ; Breast Neoplasms/surgery* ; China ; Female ; Humans ; Mastectomy

Objective To explore the value of medical three-dimensional visualization technology in preoperative precise assessment for hepatocellular carcinoma (HCC).Methods The clinical data of 24 HCC patients were analyzed retrospectively from Jan 2015 to Dec 2016 in our department.Thin-layer 320-slice CT scaning was performed and data stored in the form of DICOM.Three dimensional reconstruction and simulated hepatectomy were conducted,and correlation test analysis was performed.Results The volume of simulated resected liver was (565 ± 296)ml,while the actual liver resection volume was(523 ± 252)ml.There was no significant difference between the predicted and the actual values (t =1.734,P ＞ 0.05).The actual liver resection volume was positively correlated with the predicted liver resection volume (r =0.920,P ＜ 0.05).The stimulated resection margin was (1.2 ± 0.6)cm,while the actual resected tumor margin was (1.0 ± 0.5) cm.There was no significant difference between the predicted and the actual values (t =1.853,P ＞0.05).The actual margin was positively correlated with the predicted one (r =0.956,P ＜ 0.05).Conclusion The three-dimensional visualization technology has a certain degree of clinical value in the preoperative evaluation of HCC.

Differences of protonated and lithiated leucine-enkephalin(LE) were investigated by hydrogen deuterium exchange-mass spectrometry(HDX-MS) combined with quantum chemistry calculation. The results revealed that the protonated ions possessed very high product yield with all hydrogen atoms being exchanged, while the reaction of lithiated LE stopped after exchanging five hydrogen atoms in the same experimental conditions. The different HDX behaviours probably indicated their conformational differences. To further clarify the experimental results, the most stable conformations of protonated and lithiated leucine-enkephalin were calculated by density functional theory. It was found that terminal amino group was the most thermodynamically stable protonation site,while Li+in coordination of four carbonyl oxygen atoms formed the most favourable lithiated LE. The reaction field reduction of lithium LE was probably due to the less acidity of hydrogen atoms and the increasing rigid conformation change induced by lithium ion.

OBJECTIVETo study the characteristics of viral spectrum and clinical features of children in pediatric intensive care unit (PICU).

METHODNasopharyngeal aspirate specimens (NPA) from 349 patients(1 from each) and 130 cerebrospinal fluids (CSF) specimens were collected from children who were admitted to the PICU of Second Affiliated Hospital of Shantou University Medical College. Additional 87 NPA specimens were collected from healthy children for routine examination on the physical examination center, and the clinical data were collected. Multiplex PCR was applied to detect 16 kinds of viruses from NPA and CSF. Fluorescence quantitative PCR was applied to detect 13 viruses from CSF and to analyze the clinical data of positive cases.

RESULTThere were 209 samples (59.9%) of the 349 NPA specimens were positive for viruses, which included 117 cases positive for human rhinovirus (HRV), 60 for respiratory syncytial virus (RSV), 20 for influenza virus A (Inf A), 10 for adenovirus (ADV), 6 for parainfluenza virus type 3(PIV-3), 6 for human Boca virus (HBoV), 5 for influenza virus C(Inf C), 4 for parainfluenza virus type 4(PIV-4), 4 for human coronavirus-HKU1/OC43, 3 for influenza virus B (Inf B), 3 for WU Polyomavirus (WUPyV), 2 parainfluenza virus type 1(PIV-1), 2 human metapneumovirus (HMPV) and 1 human coronavirus-NL63/229E. But none from 87 healthy controls were positive for any respiratory virus. Among the 130 CSF specimens, in 58 cases the diagnosis was viral encephalitis. There were 22 samples (37.9%) among the 58 CSF specimens positive for viruses, which included 14 enterovirus (EV), 3 human cytomegalovirus (HCMV), 2 mumps virus, 1 coxsackie virus A16 (Cox-A16), 1 herpes simplex virus (HSV) and 1 human rhinovirus (HRV). The total positive rate was 63.3% (221/349) . Co-infection by at least 2 viral pathogens under study was observed in 45 of the 349 patients (12.9% of the total number of cases, 20.4% of the positives cases). The commonest pathogens in co-infected samples were WUPyV (100%) and HMPV(100%). The positive rate of virus peaked in the first 6 months of life, the rate in boys were higher than in girls and the peak season was summer. The numbers of none serious cases in the virus positive group were less than those in the virus negative group while the numbers of extremely serious cases in the virus positive group were higher than in the virus negative group.

CONCLUSIONViral pathogen is a major cause of infectious disease in pediatric critical illnesses and virus infection may lead to severe illness.

Acute Disease ; Age Distribution ; Child ; Child, Preschool ; Coinfection ; virology ; Encephalitis, Viral ; epidemiology ; virology ; Female ; Humans ; Infant ; Influenza A virus ; isolation & purification ; Intensive Care Units, Pediatric ; Male ; Polymerase Chain Reaction ; RNA Viruses ; isolation & purification ; Respiratory Syncytial Viruses ; isolation & purification ; Respiratory Tract Infections ; epidemiology ; virology ; Rhinovirus ; isolation & purification ; Virus Diseases ; epidemiology ; virology

Objective To investigate the prevalence and clinical features of human rhinovirus (HRV) infection in hospitalized children with acute respiratory (ARI) in eastern areas of Guangdong province from 2008 to 2010.Methods From Oct.2008 through Sep.2010,nasopharyngeal aspirates were collected prospectively,from hospitalized children with acute lower respiratory tract infection at the Second Hospital,affiliated to the Shantou University Medical College.Multiplex PCR was applied to detect ten kinds of viruses including HRV,RSV in the hospitalized children with respiratory tract infection.Clinical data on HRV-positive cases or RSV-positive cases were collected and analyzed.Results Among all the 1335 specimens,124 were confirmed as HRV-positive cases (9.3％),with IVA-positive rate as the highest (25.1％),followed by RSV-positive rate (15.1％).HRV infection occurred sporadically around the year,with the highest HRV-positive rate seen in spring 2009 and autumn in 2010.Symptoms,signs,chest X-ray,leukocyte count and CRP count did not differ between patients with co-infection or single HRV infection.Clinical symptoms or signs were similar between those with single HRV infection or single RSV infection in children,but the single RSV infected children were more frequently seen with wheeze and cough.28.4％ of the single RSV infected children had bronchiolitis while 10.7％ of single HRV infected children were seen (x2=0.281,P=0.596).Conclusion HRV was a relatively common cause for acute respiratory infections in the eastern areas of Guangdong province.The highest HRV-positive rate was slightly different in different years.Infants and young children were generally susceptible to rhinovirus infection.Bronchiolitis,wheeze and cough associated with HRV infection happened less than those caused by RSV.

OBJECTIVEWU polyomavirus (WUPyV), a new member of the genus Polyomavirus in the family Polyomaviridae, has been found to be associated with respiratory tract infections recently. But the role of the WUPyV as agents of human disease remains uncertain. We sought to describe the detection and clinical characterization of WUPyV in acute respiratory tract infection in children.

METHODFrom July 2008 through June 2009, nasopharyngeal aspirates were collected from 771 children who were hospitalized with acute respiratory tract infection in Second Affiliated Hospital of Shantou University Medical College, and from 82 asymptomatic children who visited the health checkup clinic. WUPyV was detected by using PCR technology and was identified by using DNA sequencing. All WUPyV-positive specimens were screened for 9 common viruses [influenza A and B, respiratory syncytial virus (RSV), parainfluenza virus (PIV) 1 and 3, human metapneumovirus, human bocavirus, adenovirus and rhinovirus] by using PCR or RT-PCR. The clinical data of WUPyV infection were collected and analyzed.

RESULTIn this study, fifteen of the 771 tested specimens with acute respiratory tract infection were positive for WUPyV, the positive rate was 1.95% and all of the asymptomatic children who visited the health checkup clinic were negative. Of the 15 cases who were positive for the virus, the age range was 2 to 48 (mean 18.8) months, 9 (60%) were male and 6 (40%) were female. WUPyV was the sole virus detected in 9 specimens (60%) from patients with acute respiratory tract infection. WUPyV was associated with the co-infection with another respiratory virus in 6 of 15 (40%) cases, most frequently with RSV (n = 4), followed by adenovirus (n = 1) and rhinovirus (n = 1). The most common clinical findings in the patients with WUPyV were cough, fever and wheezing. The most frequent diagnoses were pneumonia (n = 8), bronchiolitis (n = 4), upper respiratory tract infections (n = 2) and bronchitis (n = 1). A severe case was complicated with viral encephalitis.

CONCLUSIONWUPyV may be a respiratory pathogen because it was the sole virus detected in 9 specimens from patients with respiratory illness and all of the asymptomatic controls were negative. The most common clinical findings are cough and wheezing. Young children may be susceptible to infection with this virus and occasionally the infection with this virus may cause severe disease. More comprehensive and in-depth studies are required to prove the pathogenicity of these viruses.

Child ; Child, Preschool ; Female ; Genes, Viral ; Humans ; Infant ; Infant, Newborn ; Male ; Polymerase Chain Reaction ; Polyomavirus ; genetics ; isolation & purification ; Polyomavirus Infections ; physiopathology ; virology ; Respiratory Tract Infections ; virology

Background and Objective: Treatment planning for radiotherapy of upper thoracic esophageal carcinoma is challenging due to the anatomical features. The difficulty may be resolved by intensity-modulated radiotherapy (IMRT).This study was to compare the dosimetric advantages of IMRT to that of conformal radiotherapy (CRT) for upper thoracic esophageal carcinoma, and to explore the clinical application of IMRT. Methods: Eleven patients with upper thoracic esophageal carcinoma were enrolled. In addition to the actually used CRT plan,a five-field IMRT plan was generated for each case. The parameters of dose volume histogram for targets and organs at risk were compared between two techniques. Results: For the planning target volume (PTV) of tumor and para-tumor tissues, the mean dose, maximal dose, doses covering 99% and 95% volume were similar in IMRT and CRT plans (P＞0.05). However, IMRT plan had a higher conformity index than CRT plan (0.68 ±0.04 vs. 0.46 0.11, P＜0.01). For the PTV of supraclavicular region, IMRT plan showed a better dose heterogeneity index than CRT plan (1.17 0.05 vs. 1.33 0.15, P=0.01). IMRT plan had lower maximal dose to the planning risk volume of the spinal cord (44.4 Gy vs, 52.5 Gy, P＜0.05) and lower lung volume received dose of 10 Gy or higher [(32 6)%vs. (35 9)%, P＜0.05] than CRT plan. Conclusion: For the upper thoracic esophageal carcinoma,IMRT has more conformal distribution of dose and better spinal cord sparing than CRT, and can reduce the volume of lung that received dose of 10 Gy or higher.

OBJECTIVETo understand the etiology of pneumonia in hospitalized patients less than 3 years of age.

METHODSA total of 316 children with pneumonia admitted to the Children's Hospital of Suzhou University in Jiangsu Province from March, 2006 to January, 2007 were enrolled in this study. Sputum samples were obtained by deep nasotracheal aspiration technique for bacterial and viral cultures.

RESULTSOf the 316 samples, specific microbial etiology was obtained in 192 cases (60.8%). Bacterial infection was found in 162 cases (51.3 %), viral infection in 19 cases (6.3%)and compound infection with virus and bacteria in 11 cases (3.5 %). Haemophilus influenzae was the most common agent (46 cases; 14.6%) in bacterial infection, followed by Streptococcus pneumoniae (32 cases; 10.1%). Respiratory syncycial virus (RSV) was the most common agent (12 cases; 4.0%) in viral infection, followed by adenovirus (11 cases; 3.6%).

CONCLUSIONSBacterial infection was a leading cause of pneumonia in children less than 3 years of age in Suzhou area. Haemophilus influenzae was the most common agent, followed by Streptococcus pneumoniae.

Child, Preschool ; Hospitalization ; Humans ; Infant ; Infant, Newborn ; Pneumonia ; etiology ; Sputum ; microbiology