Objective:To investigate the dynamic changes of oral saliva flow, pH value, and bacterial flora before and after radiotherapy in patients with nasopharyngeal carcinoma (NPC) treated with intensity modulated radiotherapy, and to analyze the influencing factors of severe radioactive oral mucositis.Methods:One hundred NPC patients who received radiotherapy for the first time in the Head and Neck Radiotherapy Ward of Shandong Cancer Hospital and Institute from June 2, 2021 to December 30, 2022 were selected. Oral saliva flow, pH value and bacterial flora were measured at 5 time points, namely before radiotherapy, 15 times of radiotherapy, 35 times of radiotherapy, 1 month and 3 months after radiotherapy in patients with NPC, and the dynamic changes of 3 indicators were analyzed at each time. The factors of the occurrence of severe radioactive oral mucositis in patients with NPC were analyzed by univariate and multivariate logistic regression 15 times of radiotherapy.Results:The saliva flow of patients with NPC before radiotherapy, 15 times of radiotherapy, 35 times of radiotherapy, 1 month after and 3 months after radiotherapy were (16.51±1.29), (8.64±1.31), (5.15±1.14), (4.78±1.36) and (5.67±1.27) ml, respectively, with a statistically significant difference ( F=2 171.94, P<0.001). Oral saliva flow decreased to the lowest level 1 month after radiotherapy and then increased (all P<0.05). The pH values of patients with NPC before radiotherapy, 15 times of radiotherapy, 35 times of radiotherapy, 1 month after and 3 months after radiotherapy were 8.28±0.67, 5.87±0.53, 5.32±0.55, 6.04±0.83, 6.74±0.63, respectively, with a statistically significant difference ( F=370.43, P<0.001). The pH value decreased successively after 15 and 35 times of radiotherapy, and gradually increased 1 month and 3 months after radiotherapy (all P<0.05). There was a statistically significant difference ( χ2=18.24, P<0.001) in the detection rate of pathogenic bacteria in patients with NPC before radiotherapy (6%, 6/100), 15 times of radiotherapy (62%, 62/100), 35 times of radiotherapy (60%, 60/100), 1 month after radiotherapy (40%, 40/100) and 3 months after radiotherapy (29%, 29/100). Compared with before radiotherapy, there were statistically significant differences in the detection rates of pathogenic bacteria between 15 times of radiotherapy and 35 times of radiotherapy ( χ2=1.90, P=0.001; χ2=1.63, P=0.005). There was no statistically significant difference in the detection rate of pathogenic bacteria between 15 times of radiotherapy and 35 times of radiotherapy ( χ2=0.27, P=0.644). Compared with before radiotherapy, there was no statistically significant difference in the detection rate of pathogenic bacteria 1 month after radiotherapy and 3 months after radiotherapy ( χ2=1.30, P=0.024; χ2=0.83, P=0.149). Of 100 cases of NPC radiotherapy, 70 patients developed severe radiation oral mucositis (≥ grade 3). There were statistically significant differences in severe radioactive oral mucositis among patients with different smoking history ( χ2=8.84, P=0.003), alcohol drinking ( χ2=23.94, P<0.001), chemotherapy ( χ2=40.41, P<0.001), oral hygiene ( χ2=8.16, P=0.004), oral pH ( χ2=16.83, P<0.001) and oral pathogens ( χ2=8.80, P=0.003). Multivariate analysis showed that, alcohol drinking ( OR=2.23, 95% CI: 1.98-6.04, P=0.006), chemotherapy ( OR=3.13, 95% CI: 2.62-6.87, P<0.001) and oral pathogens ( OR=3.11, 95% CI: 1.04-9.31, P=0.043) were independent influencing factors for the occurrence of severe radioactive oral mucositis in NPC patients with radiotherapy. Conclusion:The oral saliva flow of patients with NPC decreases gradually from the beginning of radiotherapy to the lowest 1 month after radiotherapy and then increases. The pH value gradually decreases from the beginning of radiotherapy to 35 times of radiotherapy, and gradually increases from 1 month to 3 months after radiotherapy. The detection rate of pathogenic bacteria increases rapidly from the beginning of radiotherapy to 15 times of radiotherapy, and the growth rate is stable from 15 times of radiotherapy to 35 times of radiotherapy, and tended to be normal 1 month after radiotherapy. Drinking history, chemotherapy history and oral pathogens are independent risk factors influencing the occurrence of severe radioactive oral mucositis.

Objective:To explore the application effect of hierarchical constraint management scheme in ICU patients.Methods:From March 2018 to February 2020, the convenient sampling was used to select 195 patients admitted to ICU of the First Affiliated Hospital of Air Force Medical University as the research objects. Patients admitted from March 2018 to February 2019 were set as the control group ( n=97) , and routine constraint management was implemented. Patients admitted from March 2019 to February 2020 were set as the observation group (n=98) , and hierarchical constraint management was implemented on the basis of the control group. The incidence of delirium, unplanned extubatino, and constraint-related complications were compared between the two groups. Results:The total incidences of unplanned extubation and constraint-related complications in the observation group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The application of hierarchical constraint management scheme in ICU patients can reduce the risk of unplanned extubation, which can provide reference for the nursing plan of risk management of unplanned extubation and constraining related complications in ICU patients.

Objective:To explore the independent risk factors of preoperative CT findings affecting the overall survival of patients with clear cell renal cell carcinoma (ccRCC) and to draw a nomogram.Methods:The retrospective study was performed on 238 patients with ccRCC who underwent preoperative CT scan and were pathologically confirmed in First Affiliated Hospital of Air Force Medical University from October 2011 to December 2015. CT findings of each patient were evaluated by two radiologists, and general information, renal function examination, and World Health Organization/International Society for Urology and Pathology (WHO/ISUP) grading were collected. The Kaplan-Meier survival curve was plotted, and survival rates were compared using log-rank test. Cox proportional hazard regression was used for univariate and multivariate analysis, and the nomogram was drawn according to the results of multivariate analysis, and the C-index was calculated after internal validation by Bootstrap 1000.Results:After 3-74 months of follow-up for 238 patients, 32 cases were in the death group and 206 cases were in the censored group. The tumor diameter of the death group [(65.70±27.29) mm] was larger than that of the censored group [(46.25±26.16) mm], with a statistically significant difference ( t=-3.889, P<0.001). The incidence rate of tumor necrosis ( χ2=45.716, P<0.001), regional lymph node enlargement ( χ2=43.342, P<0.001) and perirenal fat invasion ( χ2=19.324, P<0.001) in the death group were higher than those in the censored group. Survival rates were different in patients with different tumor diameter of ccRCC, with a statistically significant difference ( χ2=17.108, P<0.001). The survival rate of patients with tumor necrosis was lower than those without necrosis ( χ2=48.195, P<0.001). The survival rate of patients with regional lymph node enlargement was lower than those without regional lymph node enlargement ( χ2=47.232, P<0.001). The survival rate of patients with perirenal fat invasion was lower than those without perirenal fat invasion ( χ2=19.964, P<0.001). Survival rates were also different in ccRCC patients with different WHO/ISUP grades, with a statistically significant difference ( χ2=27.765, P<0.001). In Cox multivariate analysis, tumor diameter ( HR=2.90, 95% CI: 1.37-6.14, P=0.006), necrosis ( HR=8.88, 95% CI: 3.33-23.69, P<0.001) and regional lymph node enlargement ( HR=4.48, 95% CI: 2.04-9.86, P<0.001) in CT findings were independent risk factors for death in patients with ccRCC. The C-index of nomogram was 0.870. Conclusion:Preoperative CT findings are correlated with survival rate of patients with ccRCC, in which tumor diameter, tumor necrosis and regional lymph node enlargement are independent risk factors for death, and the nomograms has high accuracy.

Calcium-binding protein is an indispensable protein which performs extensive and important functions in the growth of Schistosoma japonicum. Based on our primary study on tegument surface proteins of S. japonicun, a cDNA encoding a 66 kDa calcium-binding protein of S. japonicum (Chinese strain) was cloned, sequence analysis revealed that it was identical with that of SjIrV1 of Philippines strains S. japonicum. The expression of SjIrV1 were detected by Real-time PCR, using cDNA templates isolated from 7, 14, 21, 28, 35 and 42 days worms and the results revealed that the gene was expressed in all investigated stages, and the mRNA level of SjIrV1 is much higher in 42 d female worms than that in 42 d male worms. The cDNA containing the open reading frame of IrV1 was subcloned into a pET28a (+) vector and transformed into competent Escherichia coli BL21 for expression. The recombinant protein was purified using a Ni-NTA purification system, and confirmed by high performance liquid chromatography (RP-HPLC) and tandem mass spectrometry (MS/MS). Western blotting analysis showed that recombinant SjIrV1 (rSjIrV1) could be recognized by the S. japonicum infected mouse serum and the mouse serum specific to rSjIrV1, respectively. Immunofluorescence observation exhibited that SjIrV1 was mainly distributed on the tegument of the 35-day adult worms. ELISA test revealed that IgG, IgG1 and IgG2a antibodies are significantly increased in the serum of rSjIrV1 vaccinated mice. The study suggested that rSjIrV1 might play an important role in the development of S. japonicum.
Animals ; Antibodies, Helminth ; blood ; Calcium-Binding Proteins ; genetics ; metabolism ; Cloning, Molecular ; Escherichia coli ; metabolism ; Female ; Genetic Vectors ; Helminth Proteins ; genetics ; metabolism ; Male ; Mice ; Recombinant Proteins ; genetics ; metabolism ; Schistosoma japonicum ; genetics ; metabolism