Objective:To analyze the value of carotid plaque neovascularization grading in predicting the risk of ischemic stroke.Methods:Thirty-five patients with ischemic stroke and carotid atherosclerotic plaques, admitted to Ningbo No. 4 Hospital from June 2022 to June 2024, were retrospectively included in the study group. Additionally, 25 patients with only carotid atherosclerotic plaques admitted during the same period were included in the control group. Ultrasound examination was performed to assess the neovascularization grading in the carotid atherosclerotic plaques of the enrolled patients. The clinical data of both groups were compared. Pearson's correlation analysis was performed to analyze the relationship between D-dimer levels, neovascular grading in the plaques, and the onset of ischemic stroke. Logistic regression was applied to identify multiple risk factors for the onset of ischemic stroke.Results:D-dimer levels and the percentages of grades Ⅲ and Ⅳ neovascularization in the study group were (845.68 ± 101.02) μg/L, 51.4% (18/35), and 31.4% (11/35), respectively. These values were significantly higher than those in the control group [(446.89 ± 103.25) μg/L, 24.0% (6/25), 8.0% (2/25)]. The percentage of grade Ⅱ neovascularization in the study group was significantly lower than that in the control group [5.7% (2/35) vs. 36.0% (9/25)]. All differences between the two groups were statistically significant ( t = 7.82, χ2 = 8.93, 4.57, 4.72, P < 0.001, P = 0.003, P = 0.033, P = 0.030). Pearson's correlation test indicated a positive correlation between D-dimer level, carotid plaque neovascularization grade, and the onset of ischemic stroke ( r = 0.825, 0.826, both P < 0.05). Multivariate logistic regression analysis showed that D-dimer level and carotid plaque neovascularization grade were significant risk factors associated with the incidence of ischemic stroke ( OR = 3.414, 3.449, both P < 0.05). Conclusions:D-dimer level and carotid plaque neovascularization grade have high value in predicting the risk of ischemic stroke.

OBJECTIVE To observe the detection and drug resistance of carbapenem-resistant Klebsiella pneumoni-ae(CRKP)strains causing hospital-acquired infections(HAI)and community-acquired infections(CAI)in recent years so as to provide bases for prevention and control of CRKP infection and reasonable clinical use of antibiotics.METHODS A total of 3444 patients who were diagnosed with Klebsiella pneumonia infection and were hospitalized in the 2nd Affiliated Hospital of Fujian Medical University from Jan.1,2017 to Dec.31,2023 were recruited as the research subjects.Totally 230 patients with CRKP infection were chosen based on the result of drug susceptibility testing,73 of whom had HAI,and 157 had CAI.The isolation rate of CRKP strains,popula-tion distribution,specimens sources and drug resistance rates were observed and compared between the patients with HAI and the patients with CAI.RESULTS The total isolation rate of CRKP strains was 6.68％(230/3444).There was no difference in the sex of the patients with CRKP infection between the HAI patients and the CAI patients,however,the isolation rate of the CRKP strains from the patients aged between 18 and 45 years old was higher in the HAI group than in the CAI group(P＜0.05).The isolation rates of CRKP strains causing the two types of infections increased year by year,showing a remarkable increasing amplitude in 2022-2023,with the HAI increasing from 9.33％to 20.67％,the CAI increasing from 5.54％to 15.03％.The lower respiratory tract,urinary tract and bacteremia were the most common infection sites,the detection rate of soft tissue infec-tions was higher among the patients with HAI than among the patients with CAI(P=0.047).CRKP strains cau-sing HAI showed the highest isolation rate(33.33％)in catheter specimens,and the isolation rate of CRKP strains in pus specimens was higher among the HAI patients than among the CAI patients(P=0.011).The isola-tion rate of CRKP strains in sputum specimens of the CAI patients raised four times in 2023 as compared with that in 2022.The drug resistance rates of the CRKP strains to 25 types of antibiotics were relatively high and showed upward trends;the drug resistance rate of the HAI-KPN strains to imipenem was 48.78％,higher than 7.09％of the CAI-KPN strains(P＜0.001),and there were no significant differences in the drug resistance rates to other carbapenems between the CAI-KPN strains and the HAI-KPN strains.CONCLUSIONS The isolation rates of the CRKP strains causing the HAI and CAI are increasing year by year.The clinical invasive procedures and community-acquired respiratory tract infections are the key points for prevention and control.It is necessary to in-tensify the hospital-community cooperative prevention and control system based on the isolation rates and drug re-sistance rates of the CRKP strains,and take comprehensive prevention and control measures so as to curb the transmission of the drug-resistant strains.

OBJECTIVE To observe the detection and drug resistance of carbapenem-resistant Klebsiella pneumoni-ae(CRKP)strains causing hospital-acquired infections(HAI)and community-acquired infections(CAI)in recent years so as to provide bases for prevention and control of CRKP infection and reasonable clinical use of antibiotics.METHODS A total of 3444 patients who were diagnosed with Klebsiella pneumonia infection and were hospitalized in the 2nd Affiliated Hospital of Fujian Medical University from Jan.1,2017 to Dec.31,2023 were recruited as the research subjects.Totally 230 patients with CRKP infection were chosen based on the result of drug susceptibility testing,73 of whom had HAI,and 157 had CAI.The isolation rate of CRKP strains,popula-tion distribution,specimens sources and drug resistance rates were observed and compared between the patients with HAI and the patients with CAI.RESULTS The total isolation rate of CRKP strains was 6.68％(230/3444).There was no difference in the sex of the patients with CRKP infection between the HAI patients and the CAI patients,however,the isolation rate of the CRKP strains from the patients aged between 18 and 45 years old was higher in the HAI group than in the CAI group(P＜0.05).The isolation rates of CRKP strains causing the two types of infections increased year by year,showing a remarkable increasing amplitude in 2022-2023,with the HAI increasing from 9.33％to 20.67％,the CAI increasing from 5.54％to 15.03％.The lower respiratory tract,urinary tract and bacteremia were the most common infection sites,the detection rate of soft tissue infec-tions was higher among the patients with HAI than among the patients with CAI(P=0.047).CRKP strains cau-sing HAI showed the highest isolation rate(33.33％)in catheter specimens,and the isolation rate of CRKP strains in pus specimens was higher among the HAI patients than among the CAI patients(P=0.011).The isola-tion rate of CRKP strains in sputum specimens of the CAI patients raised four times in 2023 as compared with that in 2022.The drug resistance rates of the CRKP strains to 25 types of antibiotics were relatively high and showed upward trends;the drug resistance rate of the HAI-KPN strains to imipenem was 48.78％,higher than 7.09％of the CAI-KPN strains(P＜0.001),and there were no significant differences in the drug resistance rates to other carbapenems between the CAI-KPN strains and the HAI-KPN strains.CONCLUSIONS The isolation rates of the CRKP strains causing the HAI and CAI are increasing year by year.The clinical invasive procedures and community-acquired respiratory tract infections are the key points for prevention and control.It is necessary to in-tensify the hospital-community cooperative prevention and control system based on the isolation rates and drug re-sistance rates of the CRKP strains,and take comprehensive prevention and control measures so as to curb the transmission of the drug-resistant strains.

Objective:To analyze the value of carotid plaque neovascularization grading in predicting the risk of ischemic stroke.Methods:Thirty-five patients with ischemic stroke and carotid atherosclerotic plaques, admitted to Ningbo No. 4 Hospital from June 2022 to June 2024, were retrospectively included in the study group. Additionally, 25 patients with only carotid atherosclerotic plaques admitted during the same period were included in the control group. Ultrasound examination was performed to assess the neovascularization grading in the carotid atherosclerotic plaques of the enrolled patients. The clinical data of both groups were compared. Pearson's correlation analysis was performed to analyze the relationship between D-dimer levels, neovascular grading in the plaques, and the onset of ischemic stroke. Logistic regression was applied to identify multiple risk factors for the onset of ischemic stroke.Results:D-dimer levels and the percentages of grades Ⅲ and Ⅳ neovascularization in the study group were (845.68 ± 101.02) μg/L, 51.4% (18/35), and 31.4% (11/35), respectively. These values were significantly higher than those in the control group [(446.89 ± 103.25) μg/L, 24.0% (6/25), 8.0% (2/25)]. The percentage of grade Ⅱ neovascularization in the study group was significantly lower than that in the control group [5.7% (2/35) vs. 36.0% (9/25)]. All differences between the two groups were statistically significant ( t = 7.82, χ2 = 8.93, 4.57, 4.72, P < 0.001, P = 0.003, P = 0.033, P = 0.030). Pearson's correlation test indicated a positive correlation between D-dimer level, carotid plaque neovascularization grade, and the onset of ischemic stroke ( r = 0.825, 0.826, both P < 0.05). Multivariate logistic regression analysis showed that D-dimer level and carotid plaque neovascularization grade were significant risk factors associated with the incidence of ischemic stroke ( OR = 3.414, 3.449, both P < 0.05). Conclusions:D-dimer level and carotid plaque neovascularization grade have high value in predicting the risk of ischemic stroke.

OBJECTIVES: To study the feasibility of ArcCHECK-3DVH system in dosimetric verification for stereotactic body radiaotherapy (SBRT) with flattening filter free (FFF) model. METHODS: SBRT treatment plans for 57 patients were introduced into ArcCHECK phantom and recalculated. The calculated dose distribution of treatment planning system and the measured dose distribution of ArcCHECK phantom were compared by γ analysis. Then the 3 dimensional dose distribution of target and organs at risk was reconstructed by 3DVH software. The reconstructed dose and calculated dose with treatment planning system (TPS) were compared, and the dose volume γ pass rate and deviation of dose volume parameters to the target and organs at risk were quantitatively valuated. RESULTS: Based on the threshold criteria (3%, 3 mm, 10%), namely the deviation of measuring points between the planned value and the measured value was less than 3%, and the proportion of points with similar values in the plane or sphere with the center of the point and the radius of 3 mm was 10%, the relative and absolute dose pass rates of SBRT treatment plans in ArcCHECK system via γ analysis were greater than 95%. Based on the stricter threshold criteria (2%, 2 mm, 10%), the relative and absolute dose pass rates of SBRT treatment plan in ArcCHECK system via γ analysis were about 93%. In 3DVH dose verification, the γ pass rate of target and organs at risk was exceed 97%, and the deviations in 3DVH of the target and organs at risk were less than ±5%. CONCLUSIONS The ArcCHECK-3DVH system in dose verification can provide more comprehensive dose distribution information to reasonably evaluate the SBRT plan, with more significance for guiding clinical treatment.
Humans ; Phantoms, Imaging ; Quality Assurance, Health Care ; Radiometry ; Radiosurgery ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated

Objective:To analyze the distribution and drug sensitivity of pathogens and cerebrospinal fluid (CSF) related measurements in AIDS patients with central nervous system (CNS) infections in Chongqing, so as to provide guidance for etiological diagnosis and rational use of antibiotics in AIDS patients with CNS infections.Methods:A total of 173 AIDS patients with CNS infections were divided into fungal group, Gram-positive bacilli group, Gram-positive cocci group and Gram-negative bacilli group. During the same period, 198 AIDS patients with non-CNS infection visited this hospital were enrolled into the control group. CSF and blood were collected for bacterial culture. The composition and drug resistance of pathogens were analyzed. The levels of CSF related measurements were determined and compared.Results:A total of 173 strains of pathogens were isolated from the CSF of the AIDS patients with CNS infections. The 173 strains included 101 (58.38%) fungi, 39 (22.54%) Gram-positive bacilli, 24 (13.87%) Gram positive cocci and 9 (5.20%) Gram-negative bacilli; 230 strains of pathogens were isolated from the blood of the AIDS patients with non CNS infections. The 198 strains were composed of 107(54.04%) fungi, 65 (32.83%) Gram positive cocci and 26 (13.13%) Gram-negative bacilli. Antifungal sensitivity testing result of Cryptococcus neoformans showed that MIC of amphotericin B, fluorocytosine, fluconazole, voriconazole and itraconazole were≤4, ≤32, ≤8, ≤1 and ≤1 μg/ml. The resistance rate of Mycobacterium tuberculosis to rifampicin was 7.69%. The result of drug sensitivity of coagulase negative staphylococci isolated from patients with CNS infections and non-CNS infections were consistent. There were significant differences among Staphylococcus aureus, Enterobacteriaceae and Acinetobacter. Compared with the control group, the levels of protein were higher and the levels of chloride and glucose were lower in fungal group, Gram-positive bacteria group, Gram-positive coccus group and Gram-negative bacteria group ( t=3.408-9.249, all P<0.011). The levels of protein, adenosine deaminase (ADA) and lactic dehydrogenase (LDH) in Gram-positive bacilli group were significantly higher than those in fungal group, Gram-positive coccus group, Gram-negative bacteria group and control group ( t=3.836-7.686, all P<0.037). Conclusions:The pathogens causing CNS and blood infections in AIDS patients were widely distributed, mainly dominated by fungus. The CSF related measurements varied with different pathogens, so as to assist in the etiological diagnosis of CNS infections.

[Abstract] Objective: To detect the expression of zinc transporter 1 (ZnT1) gene in glioma tissue, and to explore its effect on the proliferation, migration and invasion of U87 cells. Methods: From October 2015 to January 2017, 20 patients with glioma, who received no chemoradiotherapy before operation, were collected from Department of Neurosurgery, the First Affiliated Hospital of China Medical University. The protein and mRNA content of ZnT1 in glioma tissues and adjacent tissues were detected by Western blotting and Realtime PCR, respectively. ZnT1 and si-ZnT1 plasmids were transfected into glioma U87 cell line respectively to construct ZnT1 over-expression U87 cell line and ZnT1 knockdown U87 cell line. The effects of ZnT1 on proliferation, migration and invasion of U87 cells were detected by MTT and transwell assay. Results: Both mRNA and protein expressions of ZnT1 in glioma tissues was significantly higher than those in adjacent tissues (all P<0.05). U87 cell lines with ZnT1 over-expression and knockdown were successfully constructed. Compared with the control group and empty plasmid control group, the proliferation (0.54±0.01 vs 0.45±0.04, 0.43±0.03, P<0.01), invasion and migration (all P<0.05) of U87 cells with ZnT1 over-expression were significantly increased at 12 h after transfection; however, the proliferation (0.37±0.03 vs 0.45±0.01, 0.44±0.03, P<0.01), invasion and migration (all P<0.05) of U87 cells with ZnT1 knockdown were decreased significantly. Conclusion: ZnT1 was highly expressed in glioma tissues, and promoted the proliferation, migration and invasion of glioma U87 cells.

[Abstract] Objective: To study the effect and possible mechanism of TGF-β2 on the invasion of glioma stem cells (GSCs). Methods: Tumor tissues of 8 patients with glioblastoma multiforme, who underwent resection at Department of Neurosurgery of the FirstAffiliated Hospital of China Medical University duringApril 2016 toApril 2017, were collected. The primary culture of glioma cells were conducted with trypsin digestion. Partial primary glioma cells were seeded into serum-free DMEM/F12 culture medium containing EGF, bFGF and B27 to obtain suspension of tumor spheres. Immunoflurenscent staining and differentiation assay were used to detect whether the tumor spheres were GSCs. TGF-β2 secretion ability of GSCs was determined by ELISAassay.After transfection of TGF-β2 siRNA, the invasion ability of glioma stem cells was determined by Transwell assay. Western blotting was used to examine the effect of TGF-β2 on expression of matrix metalloproteinases (MMP) in glioma stem cells. Results: The suspended tumor spheres were proved to be GSCs by immunofluorescent staining and differentiation assay; the tumor spheres expressed the marker of GSCs（CD133）and had the ability to multi-differentiate (glia and neuronal cells). Compared with the primary glioma cells, Glioma stem cells exerted significantly improved TGF-β2 secretion ability ([74.13±3.63] vs [46.13±2.61] pg/ml, P<0.05); and TGF-β2 silencing significantly reduced the invasion ability of glioma stem cells ([105.71±8.69] vs [63.67±5.93], P<0.05) and inhibited MMP-2 and MMP-9 expressions. Conclusion: TGF-β2 can promote the invasiveness of glioma stem cells through MMP-2 and MMP-9 pathway.

To study the feasibility of ArcCheck verification system in dosimetric verification for stereotactic radiotherapy (SRT) the stereotactic radiotherapy (SRT) with flattening filter free (FFF) model.
 Methods: A total of 76 cases under SRT treatment plans were introduced into ArcCheck phantom and recalculated. Threshold criteria was set as (3%, 3 mm, 10%) or (2%, 2 mm, 10%). The calculated dose distribution and the measured dose distribution of ArcCheck phantom were compared by means of distance to agree (DTA) and Gamma analysis method respectively.
 Results: Based on the threshold criteria (3%, 3 mm, 10%), the relative and absolute mean pass rates of SRT treatment plans by DTA and Gamma analysis were greater than 95%. Based on the threshold criteria (2%, 2 mm, 10%), the relative and absolute mean pass rates of SRT treatment plan by DTA and Gamma analysis were about 90%. The dose pass rate of Gamma analysis method was slightly higher than that of DTA analysis method (P<0.001).
 Conclusion: The ArcCheck verification system is a rapid and accurate method for SRT dose verification, and discrepancies are found in different analysis methods.
Feasibility Studies ; Humans ; Phantoms, Imaging ; Radiosurgery ; methods ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated

ObjectiveTo evaluate the effect of high-frequency jec ventilation and bilevel positive airway pressure (BiPAP) ventilation in the severe dyspnea caused by central airway stenosis and explore the deferent application of two ventilation models.MethodsA retrospective analysis was designed to collect the serious dyspnea patients caused by central airway stenosis from January 2006 to January 2009.The patients were divided into group H and group B according to the different ventilation models,and the effect of relieving dyspnea and ameliorating hypoxemia was compared.ResultsSeven cases were in group H,and 9 cases were in group B.The therapeutic effect of relieving dyspnea was 14.29 ％(1/7) in group H.There were only 4 cases accepting high-frequency jec ventilation and the effect of relieving dyspnea was 25.00％(1/4).Two cases failed in high-frequency jec ventilation treatment and succeeded in BiPAP treatment thereafter,and 1 case failed in BiPAP treatment initially but was treated effectively by high-frequency jec ventilation after dyspnea relapsed.In group B,there were only 6 cases accepting BiPAP ventilation and the effect ofrelieving dyspnea was 83.33％ (5/6),and after adding the cases who accepting the sequential therapy of high-frequency jec ventilation and BiPAP ventilation the effect rate was 88.89％ (8/9).The difference had statistical significance(P =0.006).In ameliorating hypoxemia,the effect rate of group H was 100.00％ (7/7),of group B was 88.89％(8/9),and the difference had no statistical significance (P =0.563 ).Conclusions The high-frequency je ventilation is effective to relieve hypoxemia but is short of relieving dyspnea and subjective symptom,and it is suit for life support preoperative and intraoperative.The BiPAP ventilation is effective to relieve dyspnea and subjective symptom and hypoxemia,so the treatment effect is better than high-frequency jec ventilation,and it is suit in relieving symptom temporarily,pre-operative preparation and malignant tumor palliative treatment.