Objective To analyze the effects of target volume optimization on oral mucosal reaction and salivary gland function in oropharyngeal cancer patients receiving intensity-modulated radiotherapy(IMRT).Methods A total of 120 patients with oropharyngeal cancer admitted to Affiliated Hospital of Jiangsu University from April 2020 to August 2022 were selected and randomly grouped into control group(n=60,conventional IMRT)and treatment group(n=60,cervical region Ⅱ and the oral target region were optimized during IMRT).The therapeutic efficacy,parotid gland dose,incidence of acute oral mucosal reaction,dry mouth and oral pain at 3 months after IMRT were compared between two groups.The resting-state apparent diffusion coefficient(ADC)values of parotid and submandibular glands at different time points(before radiotherapy,the 4th week of radiotherapy,the end of radiotherapy and 3 months after radiotherapy)were recorded.Results The difference in the objective reaction rate between two groups was trivial[80.00％(48/60)vs 75.00％(45/60),P>0.05].The mean dose(Dmean)and V34 of the unaffected parotid gland and the Dmean and V30 of the oral cavity in treatment group were lower than those in control group(P<0.05).The incidences of acute oral mucosal reaction,dry mouth and oral pain at 3 months after radiotherapy in treatment group were 41.67％,50.00％,and 58.33％,lower than those in control group(75.00％,78.33％,and 85.00％)(P<0.05).The resting-state ADC values of parotid and submandibular glands at the 4th week of radiotherapy,the end of radiotherapy,and 3 months after radiotherapy in both two groups were higher than those before radiotherapy(P<0.05).At the 4th week of radiotherapy,the end of radiotherapy,and 3 months after radiotherapy,the resting-state ADC values of parotid and submandibular glands in treatment group were lower than those in control group(P<0.05).Conclusion Optimizing target volume during oropharyngeal IMRT can effectively prevent the occurrence of radiation-induced mucositis,alleviate oral mucosal reaction,oral pain and dry mouth,reduce parotid gland dose,and diminish the effects of IMRT on salivary gland function in patients.

This paper aims to focus on and implement strategies for preventing and resolving medical complaints and dis-putes at their emergence.The hospital promptly compiled a summary of the main problems and concerns reported from patients o-ver the past few years.It combined medical practices with the characteristics of admitted patients with severe diseases,complex treatment plans,and high risks.Since 2020,this hospital has been actively engaging with intractable high-risk patients and de-veloped a scheme that engaging clinical departments,medical management,and dispute management departments together to con-duct preoperative/pre-treatment communication.With a focus on patient management,this hospital upholds the concept of the pa-tient-centered humanistic philosophy in the process of doctor-patient communication to enhance the quality of communication.Consequently,the hospital has benefited from the communication scheme,achieving satisfactory effect in ensuring a solid medical safety and reducing the incidence of medical disputes.

Objective:To assess the clinical effectiveness and safety of Omalizumab for treating pediatric allergic asthma in real world in China.Methods:The clinical data of children aged 6 to 11 years with allergic asthma who received Omalizumab treatment in 17 hospitals in China between July 6, 2018 and September 30, 2020 were retrospectively analyzed.Such information as the demographic characteristics, allergic history, family history, total immunoglobulin E (IgE) levels, specific IgE levels, skin prick test, exhaled nitric oxide (FeNO) levels, eosinophil (EOS) counts, and comorbidities at baseline were collected.Descriptive analysis of the Omalizumab treatment mode was made, and the difference in the first dose, injection frequency and course of treatment between the Omalizumab treatment mode and the mode recommended in the instruction was investigated.Global Evaluation of Treatment Effectiveness (GETE) analysis was made after Omalizumab treatment.The moderate-to-severe asthma exacerbation rate, inhaled corticosteroid (ICS) dose, lung functions were compared before and after Omalizumab treatment.Changes in the Childhood Asthma Control Test (C-ACT) and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) results from baseline to 4, 8, 12, 16, 24, and 52 weeks after Omalizumab treatment were studied.The commodity improvement was assessed.The adverse event (AE) and serious adverse event (SAE) were analyzed for the evaluation of Omalizumab treatment safety.The difference in the annual rate of moderate-to-severe asthma exacerbation and ICS reduction was investigated by using t test.The significance level was set to 0.05.Other parameters were all subject to descriptive analysis.A total of 200 allergic asthma patients were enrolled, including 75.5% ( n=151) males and 24.5% ( n=49) females.The patients aged (8.20±1.81) years. Results:The median total IgE level of the 200 patients was 513.5 (24.4-11 600.0) IU/mL.Their median treatment time with Omalizumab was 112 (1-666) days.Their first dose of Omalizumab was 300 (150-600) mg.Of the 200 cases, 114 cases (57.0%) followed the first Omalizumab dosage recommended in the instruction.After 4-6 months of Omalizumab treatment, 88.5% of the patients enrolled ( n=117) responded to Omalizumab.After 4 weeks of treatment with Omalizumab, asthma was well-controlled, with an increased C-ACT score [from (22.70±3.70) points to (18.90±3.74) points at baseline]. Four-six months after Omalizumab administration, the annual rate of moderate-to-severe asthma exacerbation had a reduction of (2.00±5.68) per patient year( t=4.702 5, P<0.001), the median ICS daily dose was lowered [0 (0-240) μg vs. 160 (50-4 000) μg at baseline] ( P<0.001), the PAQLQ score was improved [(154.90±8.57) points vs. (122.80±27.15) points at baseline], and the forced expiratory volume in one second % predicted (FEV 1%pred) was increased [(92.80±10.50)% vs. (89.70±18.17)% at baseline]. In patients with available evaluations for comorbidities, including allergic rhinitis, atopic dermatitis or eczema, urticaria, allergic conjunctivitis and sinusitis, 92.8%-100.0% showed improved symptoms.A total of 124 AE were reported in 58 (29.0%) of the 200 patients, and the annual incidence was 0(0-15.1) per patient year.In 53 patients who suffered AE, 44 patients (83.0%) and 9 patients (17.0%) reported mild and moderate AE, respectively.No severe AE were observed in patients.The annual incidence of SAE was 0(0-1.9) per patient year.Most common drug-related AE were abdominal pain (2 patients, 1.0%) and fever (2 patients, 1.0%). No patient withdrew Omalizumab due to AE. Conclusions:Omalizumab shows good effectiveness and safety for the treatment of asthma in children.It can reduce the moderate-to-severe asthma exacerbation rate, reduce the ICS dose, improve asthma control levels, and improve lung functions and quality of life of patients.

Objective To observe the effect of deep muscle relaxation by rocuronium on oxygenation of normal frequency jet ventilation during rigid bronchoscopy procedures.Methods From December 2021 to February 2023,60 patients with central airway diseases underwent rigid bronchoscopy under general anesthesia,they were randomly divided into deep muscle relaxation group(group D,n = 30)and moderate muscle relaxation group(group M,n = 30).After induction of general anesthesia,the patients were inserted rigid bronchoscopy for jet ventilation,muscle relaxant was rocuronium in induction and maintenance.Train of four(TOF)stimulation was used to measure the depth of muscle relaxation in group M,and the TOF count was maintained at 1 or 2;In Group D,the depth of muscle relaxation was measured by post tetanic count(PTC),and the PTC was maintained at 1 or 2.After operation,Sugammadex antagonized residual muscle relaxation.Results There was no significant difference in operation time,recovery time and extubation time between the two groups(P＞0.05).The total operation time,operation pause time and anesthesia time in group D were shorter than those in group M,the dosage of muscle relaxant in group D was more than that in group M,the incidence of hypoxemia during surgery in group D was less than that in group M,the operators'satisfaction in group D was better than that in group M,and the arterial partial pressure of oxygen(PaO2)in group D was higher than that in group M at 15 min(T1)and 30 min(T2)after jet ventilation,the number of patients with postoperative sore throat in group D was less than that in group M,the differences were statistically significant(P＜0.05).Conclusion The application of deep muscle relaxation by rocuronium in rigid bronchoscopy procedures can improve the oxygenation effect of normal frequency jet ventilation,reduce the operation pause time and anesthesia time,improve the satisfaction of operators,antagonizing residual muscle relaxation with Sugammadex can relieve the worry of delayed recovery from deep muscle relaxation.

To present the clinical characteristics and the misdiagnosis rate of acute coronary syndrome manifested primarily as throat discomfort, we conducted a multicentric and retrospective study in the cardiology and otorhinolaryngology departments. Records of patients with primary complaint of throat discomfort, absence of chest pain at onset, and an ultimate diagnosis of acute coronary syndrome, as well as patients with pharyngitis (as controls) were collected from May 2015 to April 2016. The patients' main manifestations were compared. Logistic regression results showed that chest tightness, dyspnea, perspiring, and exertional throat symptoms were significantly associated with acute coronary syndrome, with odds ratios of 8.3 (95% CI 2.2-31.5), 10.9 (95% CI 1.8-66.9), 25.4 (95% CI 3.6-179.9), and 81.2 (95% CI 13.0-506.7). A total of 25 (56.82%) out of 44 acute coronary syndrome patients, who were first admitted to the otorhinolaryngology department, were misdiagnosed, with a 12% (3/25) mortality rate. Throat discomfort can be the principal manifestation of acute coronary syndrome. Such patients exhibit high misdiagnosis and mortality rates. Exertional throat symptoms, chest tightness, perspiring, and dyspnea were important indicators of acute coronary syndrome in patients whose main complaint was throat discomfort. The awareness of this condition will result in prompt diagnosis and reduce morbidity and mortality.
Acute Coronary Syndrome/etiology* ; Dyspnea/etiology* ; Humans ; Pharyngitis/diagnosis* ; Pharynx ; Retrospective Studies

Objective:To explore the serotype distribution and drug resistance of Shigella in stool samples of children under five years old with diarrhea from 2008 to 2017 in Sui County, Henan Province. Methods:A total of 4 721 stool samples of children under five years old with diarrhea were collected from Doufuyuan Clinic of Sui County during 2008 to 2017, and Shigella strains were isolated through bacterial culture. The slide agglutination test was used for serotyping of Shigella strains. Two hundred of seventy-one Shigella strains were selected in proportion, and multiple gradient polymerase chain reaction was used to detect virulence genes and Kirby-Bauer agar method was used for drug sensitivity. Trend chi square test was used to analyze the annual trend of drug resistance. Results:The detection rate of Shigella strains in 4 721 fecal samples was 20.69% (977/4 721). A total of 977 Shigella strains were divided into 13 serotypes in two groups, including 77.79%(760/977) Shigella flexneri strains and 22.21%(217/977) Shigella sonnei strains.The top three serotypes detected alternately every year.The dominant gene pattern of Shigella flexneri was Shigella enterotoxin ( shET)-1+ , shET-2+ , invasion plasmid antigen H ( ipaH)+ , invasion-associated locus ( ial)+ , accounted for 84.04%(179/213) and that of Shigella sonnei was shET-1-, shET-2+ , ipaH+ , ial+ , accounted for 46.55%(27/58). The drug resistance rates of 271 Shigella strains to ampicillin, nalidixic acid and tetracycline were more than 90% and the strains were more sensitive to cefepime and ceftazidime.The drug resistance rates to cefotaxime, cefepime, ciprofloxacin, chloramphenicol and sulfamethoxazole/trimethoprim increased year by year, and all had statistically significant differences ( χ2=24.027, 7.232, 6.039, 4.764 and 6.809, respectively, all P< 0.05). There were 98.52%(267/271) strains resistant to more than three kinds of drugs. The resistance rates of Shigella flexneri to ciprofloxacin, norfloxacin, and chloramphenicol were higher than those of Shigella sonnei, and the resistance rates to gentamicin and sulfamethoxazole/trimethoprim were lower than those of Shigella sonnei. The differences were statistically significant ( χ2=31.866, 14.868, 83.036, 68.534 and 14.738, respectively, all P<0.01). Conclusions:The major serotypes of Shigella in children under five years old in Sui County are constantly changing from 2008 to 2017. The dominant gene patterns of different serotypes are different. Most isolated strains have multiple drug resistances, and different serotypes have different resistance profiles.

Objective:To establish a mouse model of gastric cancer by inoculating MKN45 cells into mice with normal immune function utilizing microcarrier technology. Methods:A total of 60 male C57BL/6 mice were randomly divided into three groups, namely, 2D, con-trol, and 3D groups, according to the coculture system of MKN45 and microcarrier. The mouse models of gastric carcinoma were estab-lished by hypodermic injection. The time of tumorigenesis, rate of tumor formation, and pathological features were observed in each group. Results:In the 3D group, the time of tumor formation was short, whereas the rate of tumor formation was high (80%). No de-tectable tumor formations were observed in the 2D and control groups. HE and immunohistochemical staining of the transplantation tumor model showed evident characteristics of human gastric cancer. Conclusion:A human gastric cancer model in normal immune mice was successfully established. The onset and development mechanism of gastric cancer could be more effectively investigated in mice with normal immune function through this model. Moreover, a more valuable and new animal model for the research and devel-opment of anticancer drug was established.

Objective To evaluate the accuracy of an expiratory resistance device assisting pulse pressure variation (PPV) in predicting volume responsiveness in the spontaneously breathing patients.Methods Forty spontaneously breathing patients of both sexes,aged 22-61 yr,weighing 51-73 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective operation,were enrolled.Before induction of anesthesia,mean arterial pressure (MAP),heart rate (HR),central venous pressure (CVP),cardiac index (CI) and pulse pressure variation (PPVB) were recorded after haemodynamics were stable.Then the expiratory resistance device was used,and MAP,HR,CVP,CI,and PPVA were recorded.The device was then removed.Volume expansion was carried out.6％ hydroxyethyl starch 130/0.4 6 ml/kg was infused over 10 min.MAP,HR,CVP,CI and PPVB were recorded within 3 min after volume expansion.The device was used again,and 1 min later MAP,HR,CVP,CI and PPVA were recorded.The device was then removed.The patients were divided into 2 groups according the percentage of increase in CI after volume expansion (△ CI):△ CI≥ 15％ considered to be a positive response group (group P),and ACI＜15％ considered to be a negative response group (group N).A receiver-operating characteristic (ROC) curve for PPV was plotted.According to the ROC curve,the diagnostic threshold,sensitivity,specificity,area under the curve,and 95％ confidence interval of the expiratory resistance device assisting PPV in predicting volume responsiveness were determined.Results The area under the curve (95％ confidence interval) of PPVA was 0.880 (0.70-0.98),the diagnostic threshold was 13.5％,and the sensitivity and specificity in determining volume responsiveness were 87％ and 88％,respectively.Compared with the value before administration of the loading dose,the CVP and CI were significantly increased,and PPVB and PPVA were decreased after volume expansion in group P,and the CVP and CI were significantly increased after volume expansion in group N (P＜0.05).Compared with group P,the PPVA was significantly decreased before volume expansion,and the CI was increased after volume expansion in group N (P＜0.05).Conclusion The expiratory resistance device can assist PPV in predicting volume responsiveness in the spontaneously breathing patients.

OBJECTIVE: To evaluate nasal ventilation in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) after nasal cavity ventilation expansion techniques by using acoustic rhinometry. METHOD: Thirty-eight patients with mild OSAHS and 17 patients with moderate OSAHS who were diagnosis by PSG were selected. The acoustic rhinometry and rhinomanometry were used to assess the nasal cavity volumes (NCV), nasal airway resistance (NR), nasal minimal cross-section area (NMCA) and distance of nasal minimal cross-section area from nostril (DCAN) before and after the surgery (6 month later). RESULT: The state of mild OSAHS group in NCV, NMCA and NR: before surgery (2.41 ± 1.33) cm³, (0.37 ± 0.39) cm², (2.07 ± 1.48) cmH₂O/(L · min), after surgery (2.53 ± 1.54) cm³, (0.45 ± 0.34) cm², (1.69 ± 1.03) cmH₂O/(L · min), has significant difference (P < 0.05). The state of moderate OSAHS group in NCV, NMCA and NR: before surgery (2.03 ± 1.54)cm³, (0.29 ± 0.39) cm², (3.47 ± 2.56) cmH₂O/(L · min), after surgery (2.31 ± 1.47) cm³, (0.39 ± 0.33) cm², (1.89 ± 1.03)cmH₂O/(L · min), also has significant difference (P < 0.05), while DCAN in two group had no difference (P > 0.05). CONCLUSION There was an objective evaluation of nasal ventilation in OSAHS patients after surgery by using acoustic rhinometry.
Humans ; Nasal Cavity ; surgery ; Rhinometry, Acoustic ; Sleep Apnea, Obstructive ; surgery

Through the study on mathematical logic relation in the syndrome theory of traditional Chinese medicine (TCM), it revealed that the mathematical logic relation among three basic elements in the judgment of syndromes, which were the disease cause (a), disease location (b), disease nature (c) and syndrome (z), was f(z)=a+b+c. The mathematical logic relation between syndrome (z) and symptom (zi) was f(z)= z1+z2+z3+…+zi. The obvious feature reflected by the complexity of syndromes was the construction number of symptoms. During the syndrome differentiation process, the mathematical logic relation between symptom and disease cause, location, nature and syndrome was z1+z2+z3+…+zi =a+b+c= f(z). However, syndromes generally exhibited a nonlinear relationship of point-set topology. After calculation, 79 major single TCM syndromes had a total of more than 6.5×105 different forms. The number within a certain range of syndrome group was approximately 6.6×10100. The super huge data “Googol” may be the root of complex TCM syndromes. The results showed that the researches on “element of syndrome” using the bayesian networks, the neural network algorithm and the algorithm of double levels of frequency power were irrelevant to the mathematical logic relation of the intrinsic relations of syndrome theory. Therefore, “element of syndrome” was a false proposition feature in the study of TCM basic theory. The established syndrome differentiation method with“element of syndrome” as its core was not conformed to the inherent law of TCM theory and clinical practice.