OBJECTIVE To explore the changes of serum Toll-like receptor(TLR)2,TLR4 and 25 hydroxyvitamin D[25(OH)D]in the general anesthesia orthopedic surgery patients with postoperative pulmonary infections and analyze the distribution and drug resistance of pathogens.METHODS A total of 59 general anesthesia orthopedic surgery patients with postoperative pulmonary infections who were treated in Tianjin Fifth Central Hospital from Jul.2019 to Jul.2024 were chosen as the infection group,meanwhile,65 patients who underwent the same surger-y but did not have postoperative pulmonary infection or other acute and chronic infections were chosen as the non-infection group.The etiological characteristics of the postoperative pulmonary infections and the drug re-sistance rates were analyzed.The clinical data and the levels of serum TLR2,TLR4 and 25(OH)D were observed and compared between the two groups of patients.The values of the above indicators in diagnosis of the postopera-tive pulmonary infections in the general anesthesia orthopedic surgery were analyzed.RESULTS Totally 63 strains of pathogens were isolated from the 59 general anesthesia orthopedic surgery patients with postoperative pulmona-ry infections,36(57.14％)of which were gram-negative bacteria.3 of 15 Pseudomonas aeruginosa strains were resistant to meropenem;4 of 12 Klebsiella pneumoniae strians were resistant to meropenem;all of the 11 Staph-ylococcus aureus strains were methicilin-resistant S.aureus.The proportions of patients with age,hypoproteine-mia and diabetes mellitus,the serum TLR2 and TLR4 levels were higher in the infection group than in the non-infection group(P＜0.05),while the 25(OH)D level of the infection group was lower than that of the no in-fection group(P＜0.05).The area under the curves(AUCs)of serum TLR2,TLR4,25(OH)D and the joint de-tection of the above indicators were respectively 0.817,0.801,0.787 and 0.917 in diagnosis of postoperative pul-monary infections in the general anesthesia orthopedic surgery patients,and the AUC of the joint detection of the indicators was greater than that of the single detection(P＜0.05).CONCLUSIONS The general anesthesia or-thopedic surgery patients with postoperative pulmonary infections show high expressions of serum TLR2 and TLR4 and the low expression of 25(OH)D.The joint detection of the above indexes has higher diagnostic value.The gram-negative bacteria are dominant among the pathogens causing the infections.The pathogens vary in the drug resistance.

Objective To investigate the effect of four traditional Chinese drugs for reinforcing kidney combined with Tongqiao Huoxue Decoction on serum neurotransmitters and neurological func-tion in patients with post-stroke cognitive impairment(PSCI).Methods A total of 110 patients with PSCI were randomly divided into treatment group and control group,with 55 cases in each group.The control group was treated with donepezil tablet,while the treatment group was treated with four tradi-tional Chinese drugs for reinforcing kidney and Tongqiao Huoxue Decoction on the basis of the control group.The total effective rate,the Mini-Mental State Examination(MMSE)score,the Montreal Cogni-tive Assessment(MoCA)score,the National Institutes of Health Stroke Scale(NIHSS)score and the Barthel Index(BI)as well as serum levels of acetylcholine(ACh),dopamine(DA),norepinephrine(NE),5-hydroxytryptamine(5-HT),neuron-specific enolase(NSE),visinin-like protein-1(VILIP-1),myelin basic protein(MBP),and heat shock protein 70(HSP70)before and after treatment were compared between the two groups.Adverse reactions in both groups were recorded.Results The total effective rate was 90.91％in the treatment group,which was significantly higher than 76.36％in the control group(P＜0.05).After treatment,the MMSE score,MoCA score and BI as well as serum levels of ACh,DA,NE,5-HT and HSP70 in the treatment group were significantly higher than those in the control group,while the NIHSS score and serum levels of NSE,VILIP-1 and MBP were significantly lower than those in the control group(P＜0.05).The total incidence rate of adverse reactions in the treatment group and the control group was 12.73％and 9.09％respectively,which showed no significant between-group difference(P＞0.05).Conclusion Four traditional Chinese drugs for reinforcing kidney combined with Tongqiao Huoxue Decoction can promote the secretion of cognition-related neurotransmitters in patients with PSCI,accelerate the repair of neurological damage,and safety is relatively high.

OBJECTIVE To explore the changes of serum Toll-like receptor(TLR)2,TLR4 and 25 hydroxyvitamin D[25(OH)D]in the general anesthesia orthopedic surgery patients with postoperative pulmonary infections and analyze the distribution and drug resistance of pathogens.METHODS A total of 59 general anesthesia orthopedic surgery patients with postoperative pulmonary infections who were treated in Tianjin Fifth Central Hospital from Jul.2019 to Jul.2024 were chosen as the infection group,meanwhile,65 patients who underwent the same surger-y but did not have postoperative pulmonary infection or other acute and chronic infections were chosen as the non-infection group.The etiological characteristics of the postoperative pulmonary infections and the drug re-sistance rates were analyzed.The clinical data and the levels of serum TLR2,TLR4 and 25(OH)D were observed and compared between the two groups of patients.The values of the above indicators in diagnosis of the postopera-tive pulmonary infections in the general anesthesia orthopedic surgery were analyzed.RESULTS Totally 63 strains of pathogens were isolated from the 59 general anesthesia orthopedic surgery patients with postoperative pulmona-ry infections,36(57.14％)of which were gram-negative bacteria.3 of 15 Pseudomonas aeruginosa strains were resistant to meropenem;4 of 12 Klebsiella pneumoniae strians were resistant to meropenem;all of the 11 Staph-ylococcus aureus strains were methicilin-resistant S.aureus.The proportions of patients with age,hypoproteine-mia and diabetes mellitus,the serum TLR2 and TLR4 levels were higher in the infection group than in the non-infection group(P＜0.05),while the 25(OH)D level of the infection group was lower than that of the no in-fection group(P＜0.05).The area under the curves(AUCs)of serum TLR2,TLR4,25(OH)D and the joint de-tection of the above indicators were respectively 0.817,0.801,0.787 and 0.917 in diagnosis of postoperative pul-monary infections in the general anesthesia orthopedic surgery patients,and the AUC of the joint detection of the indicators was greater than that of the single detection(P＜0.05).CONCLUSIONS The general anesthesia or-thopedic surgery patients with postoperative pulmonary infections show high expressions of serum TLR2 and TLR4 and the low expression of 25(OH)D.The joint detection of the above indexes has higher diagnostic value.The gram-negative bacteria are dominant among the pathogens causing the infections.The pathogens vary in the drug resistance.

Objective:To evaluate the intra-fraction and inter-fraction positional deviations in head and neck tumor patients undergoing intensity-modulated radiation therapy(IMRT)guided by cone-beam CT(CBCT),as well as the correction capability and stability of the HexaPOD evo RT 6D couch in addressing these deviations.Methods:From May 2019 to April 2022,59 consecutive patients with head and neck tumors were enrolled at the Department of Radiation Oncology,Peking University Third Hospi-tal.Using the Elekta AXESSE image-guided stereotactic treatment system,a pre-treatment CBCT scan was performed,followed by bone window mode registration with the planning reference images.Devia-tions were corrected automatically or manually on the 6D couch,followed by a second CBCT scan for con-firmation of the deviation correction.Positional errors in translation(X,Y,Z directions)and rotation(Rx,Ry,Rz directions)were recorded before and after correction,and intra-fraction and inter-fraction positional errors were analyzed.Results:Positional error data before and after correction of the 6D couch were successfully obtained and corrected online in 506 CBCT scans.The maximum positional errors be-fore and after correction were 0.90 cm to 0.04 cm(X direction),1.74 cm to 0.09 cm(Y direction),1.80 cm to 0.09 cm(Z direction),and 2.90° to 0.14°(Rx direction),3.00° to 0.15°(Ry direc-tion),3.00° to 0.15°(Rz direction),respectively.The mean absolute values of translational(X,Y,Z directions)and rotational(Rx,Ry,Rz directions)errors significantly decreased after online correction,from 0.18 cm,0.22 cm,0.25 cm,and 0.82°,1.11°,0.73° to 0.01 cm,0.01 cm,0.01 cm,and 0.04°,0.06°,0.04°(all P values＜0.001).After correction,the frequencies of translational errors less than 0.10 cm in the X,Y,Z directions were 99.60％,98.62％,and 95.45％,respectively,and the frequencies of rotational errors less than 0.2° were all above 99.80％.Conclusion:Online correc-tion combined with CBCT and the 6D couch significantly reduces both translational and rotational posi-tional errors in patients undergoing head and neck radiation therapy,greatly enhancing the precision of treatment.

Objective:To establish a reliable sequence-based typing method for KIR2DS4 and study its allele polymorphism in Chinese Han population.Methods:Using PCR - SSP method to detect the positive or negative of KIR2DS4 gene in 222 random Chinese Han individuals, and then using the method of high fidelity and long-fragment PCR - SBT to amplified, sequence and genotype the exons 4 and 5 of KIR2DS4 positive individuals.Results:We successfully amplify the fragment with 3.2 kb length contains exons 4 and 5 of KIR2DS4 and detected the KIR2DS4 allele frequency in Chinese Han population. 209 KIR2DS4 positive individuals were detected, and the positive rate is 94.1%. By sequence-based typing, we identified 12 genotypes and 7 alleles of KIR2DS4. The 6 known alleles and their detection frequency is as follows: KIR2DS4 * 00101/011 (180, 81.1%), KIR2DS4 * 010 (53, 23.9%), KIR2DS4 * 004 (34, 15.3%), KIR2DS4 * 003 (15 and 6.8%), KIR2DS4 * 006 (2, 0.9%) and KIR2DS4 * 015 (1, 0.5%). In this study, we found a new allele, KIR2DS4 * 016, with the difference in exon 5 comparing its most similar allele KIR2DS4 * 010. In the exon 5 of KIR2DS4 * 010, there is a 22bp-deletion, while the exon 5 of KIR2DS4 * 016 is normal. This is not a rare allele because it was detected 3 times in studied population and with the frequency of 1.4%. The sequence of the new allele sequence has been submitted to GenBank (accession no.: KC414890) and the IPD - KIR database (submission no.: IWS40001804), and was nominated by WHO nomenclature committee for HLA system. Conclusion:In this study, a sequence-based typing method for KIR2DS4 was established, and the polymorphism data of KIR2DS4 in Chinese Han population was enriched by studying the allele polymorphism and new allele.

OBJECTIVE: To investigate the efficacy of image-guided radioactive 125I seed (IGRIS) implantation for pelvic recurrent cervical cancer (PRCC) after external beam radiotherapy (EBRT), and analyze the influence of clinical and dosimetric factors on efficacy. METHODS: From July 2005 to October 2015, 36 patients with PRCC received IGRIS. We evaluated local progression-free survival (LPFS) and overall survival (OS). RESULTS: The median follow up was 11.5 months. The 1- and 2-year LPFS rate was 34.9% and 20%, respectively. The multivariate analysis indicated recurrence site (central or pelvic wall) (hazard ratio [HR]=0.294; 95% confidence interval [CI]=0.121–0.718), lesion volume (HR=2.898; 95% CI=1.139–7.372), D 90 (HR=0.332; 95% CI=0.130–0.850) were the independent factors affecting LPFS. The 1- and 2-year OS rate was 52.0% and 19.6%, respectively. The multivariate analysis suggested pathological type (HR=9.713; 95% CI=2.136–44.176) and recurrence site (HR=0.358; 95% CI=0.136–0.940) were the independent factors affecting OS. The dosimetric parameters of 33 patients mainly included D 90 (128.5±47.4 Gy), D 100 (50.4±23.7 Gy) and V 100 (86.7%±12.9%). When D 90 ≥105 Gy or D 100 ≥55 Gy or V 100 ≥91%, LPFS was extended significantly, but no significant difference for OS. The 79.2% of 24 patients with local pain were suffering from pain downgraded after radioactive 125I seed implantation. CONCLUSION: IGRIS implantation could be a safe and effective salvage treatment for PRCC after EBRT, which could markedly release the pain. Recurrence site, tumor volume and dose were the main factors affected efficacy. Compared with central recurrence, it was more suitable for patients with pelvic wall recurrent cervical cancer after EBRT.
Brachytherapy ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Radiometry ; Radiotherapy* ; Radiotherapy, Image-Guided ; Recurrence ; Salvage Therapy* ; Tumor Burden ; Uterine Cervical Neoplasms*

Objective To evaluate the outcomes and prognostic factors of image-guided 125I seed implantation for locally recurrent soft tissue sarcoma(RSTS).Methods A total of 60 patients with RSTS who received image-guided 125I seed implantation in Peking University Third Hospital,from September 2002 to December 2015,were retrospectively analyzed.The enrollment criteria: KPS ＞60 points,refused or could not tolerate surgery or radiotherapy,the expecting survival time ＞3 months,relapsed after multiple treatment of soft tissue sarcoma,and underwent CT or ultrasound guided 125 I seed implantation treatment.In all,the median activity of seeds was 25.9×106Bq(range,11.1×106-29.6×106Bq),median number of implanted seeds was 58(range,3-133),and the median D90was 120 Gy(range,36.50-460.97 Gy).The local progression-free survival(LPFS)and overall survival(OS)were calculated using the Kaplan-Meier method.The log-rank test and Cox regression model were used for the univariate and multivariate analyses.Results The median follow-up was 18.75 months(range,1-146).The median OS was 18.5 months(95％CI 13.1-23.9).The 1-,3-and 5-year OS rate were 63.3％,33.0％and 29.5％,respectively.The 1-,3-and 5-year LPFS rate were 72.5％,63.7％and 59.7％,respectively.The general rate of pain relieving was 100％(6/6).8.3％(5/60)presented grade Ⅳskin toxicity.No fatal complications ocurred.The univariate analysis suggested that tumor size,tumor volume,KPS score,D90were prognostic factors of OS and LPFS.The multivariate analysis demonstrated that previous chemotherapy history and distant metastases were independent prognostic factors of survival.Conclusions Image-guided 125I seed implantation for recurrent soft tissue sarcoma is a safe treatment option with high efficacy and low morbidity.Tumor size and D90were the prognostic factors of OS and LPFS.

Objective To evaluate the efficacy and adverse effects of 125I seeds implantation for pelvic recurrence of cervical cancer (PRCC) after radiotherapy.Methods From July 2005 to October 2015,36 PRCC patients (median 44 years) after radiotherapy in Peking University Third Hospital were enrolled in this retrospective study.All patients underwent 125I seeds implantation under ultrasound or CT guidance.Treatment planning was performed before implantation to estimate the number and activity of 125I seeds.The seed numbers ranged from 10-140 (median:62.5),and the activity ranged from 18.5-29.6 (median:25.9) MBq.Postoperatively,the median dose delivered to 90％ gross tumor volume (D90) was 127.3 Gy.Kaplan-Meier method was used to calculate local progress free survival (LPFS) rate and overall survival (OS) rate,and log rank test and Cox regression were used for univariate and multivariate analyses.Results The median follow-up time was 11.5 months.The local control rate was 88.89％(32/36).The 1-year LPFS rate was 34.9％ and the 1-year OS rate was 52.0％.Thirty-one patients died,of which 22 (70.97％,22/31) died from cancer.Univariate analysis showed that the location of recurrence (x2=5.195),volume of lesion (hazard ratio (HR)=1.012) and D90(HR=0.988) were significantly correlated with LPFS (all P＜0.05).Multivariate analysis showed that the location of the recurrence was significantly related with LPFS (HR =0.215,P＜0.05).The 1-year LPFS rates of pelvic wall recurrence and central recurrence were 41.6％ and 26.7％ (x2 =5.195,P＜0.05),and 1-year OS rates were 54.7％ and 49.5％ (x2 =2.535,P＞0.05),respectively.Vaginal fistula,which may be caused by the treatment,occurred in 1 case.No other sever adverse effects were observed.Conclusions 125I seeds implantation is a safe and effective treatment for PRCC after radiotherapy.With the treatment of 125I seeds implantation,patients with pelvic wall recurrence may achieve better therapeutic effects than those with central recurrence.

Objective To investigate the significance of hypoxia inducible factor lα and lactate and lactate clearance in patients with septic shock.Methods A prospective observational study was conducted.Thirty healthy volunteers (control group) and 40 cases of septic shock patients in EICU were recruited.According to the survival time,40 patients with septic shock were divided into survival group (21 cases,survival time ＞ 28 days) and death group (19 cases,survival time ≤ 28 d).The HIF-lα level was tested by ELISA assay.Lactate level of 0,6,12,24 h in arterial blood were also tested.Lactate clearance rate of the 6 h,12 h and 24 h were calculated.The association of HIF-1α and lactate level and lactate clearance rate,APACHE Ⅱ score and prognosis were evaluated.Results 40 patients with septic shock,20 male and 20 femnales,the mean age was (61.3 ± 12.8) years.The 28 day mortality rate was 47.5％.The average APACHE Ⅱ score was (23.7 ± 4.83) and arterial blood lactate levels was (5.88 ± 2.73) mmol/L.In death group and survival group,the levels of HIF-1α levels and blood lactate were significantly higher than that in the control group (P ＜ 0.05).The death group increased more significantly (P ＜ 0.05).In death group,the 6 h,12 h and 24 h lactate clearance rate were lower than the survival group (all P ＜ 0.01).APACHE Ⅱ score were higher than that in survival group (P ＜ 0.05) and the difference is statistically significant.The lactate and HIF-1α were positively correlated (r =0.868,P ＜ 0.01).Blood lactate and HIF-1α levels were all positively correlated with APACHEⅡ score (r =0.804,P ＜ 0.01) and (r =0.811,P ＜ 0.01).Conclusion The level of HIF-1α,blood lactate,lactate clearance rate are closely related with the severity and prognosis of septic shock and may become an important indicator of the prognosis.

Objective To evaluate the efficacy of computed tomography ( CT ) image?guided 125 I radioactive seed implantation for locally recurrent rectal cancer ( LRRC ) , and to analyze the relationship between the dosimetry and prognosis. Methods A retrospective analysis was performed on the clinical data of 36 patients with LRRC who received CT image?guided 125 I seed implantation in our hospital from 2003 to 2011. Dosimetric verification was performed using CT scan immediately after 125 I seed implantation. The D90 , D100 , V100 , and V150 values were evaluated. In all the patients, the median activity of seeds was 0?7 mCi (0?4?0?8 mCi) and the median number of implanted seeds was 74(33?137). The local control (LC) and overall survival ( OS ) rates were calculated using the Kaplan?Meier method. The log?rank test and Cox regression model were used for the univariate and multivariate analyses, respectively. Results The median OS time was 16?2 months ( 95% CI= 13?5?18?9 months ) . The median LC time was 10?0 months (95% CI=6?2?13?8 months). The D90 and V100 values were (118.6±25?1) Gy and (90.0±0?3)%, respectively. The univariate analysis suggested that D90 was correlated with the LC time ( P=0?048) and V100 was correlated with the OS time ( P=0?035) . The multivariate analysis showed that a V100 value higher than 90% was a prognostic factor of OS (P=0?044). Conclusions In the treatment of LRRC using CT image?guided 125 I radioactive seed implantation, a D90 value larger than 140 Gy and a V100 value higher than 90% in the postoperative verification plan help improve the LC and OS rates. The D90 and V100 values in the postoperative verification plan may predict treatment outcomes in patients.