Objective To investigate the clinical characteristics and influencing factors of moderate-to-severe pulmonary ventilation dysfunction in occupational pneumoconiosis (hereinafter referred to as "pneumoconiosis") patients complicated with pulmonary tuberculosis. Methods A total of 136 male pneumoconiosis patients complicated with pulmonary tuberculosis suffering different degrees of pulmonary ventilation dysfunction were selected as the study subjects using the judgmental sampling method. Patients were divided into mild dysfunction and moderate-to-severe dysfunction groups based on the degrees of pulmonary ventilation dysfunction. Clinical data from patients of these two groups were collected, and influencing factors of pulmonary ventilation dysfunction were analyzed. Results The prevalence of mild dysfunction and moderate-to-severe dysfunction among the study subjects was 39.0% and 61.0%, respectively. The proportion of patients with moderate-to-severe pulmonary ventilation dysfunction increased with the progression of pneumoconiosis (P<0.05). Patients in moderate-to-severe dysfunction group had higher rates of dyspnea, elevated C-reactive protein, coexisting chronic obstructive pulmonary disease (COPD), and a history of lung infections within the past two years compared with those in the mild dysfunction group (all P<0.05). The result of multivariate logistic regression analysis showed that the degree of pneumoconiosis, complicated with COPD, and a history of lung infections within the past two years were risk factors for moderate-to-severe pulmonary ventilation dysfunction (all P<0.05). Specifically, higher degree of pneumoconiosis was associated with a greater proportion of moderate-to-severe dysfunction, and patients complicated with COPD or had a history of lung infections within the past two years were more likely to experience severe pulmonary ventilation dysfunction. Conclusion The degree of pneumoconiosis, complicated with COPD, and a history of lung infections within the past two years are influencing factors of moderate-to-severe pulmonary ventilation dysfunction in patients with pneumoconiosis combined with pulmonary tuberculosis. Early detection of pneumoconiosis progression, timely diagnosis of COPD and lung infections, and appropriate treatment such as antifibrotic agents, inhaled bronchodilators, and anti-infective therapies are recommended.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

Objective:To compare and analyze the clinical features of patients with severe coronavirus disease 2019 (sCOVID-19) and severe community acquired pneumonia (sCAP) who meet the diagnostic criteria for severe pneumonia of the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS).Methods:A retrospective comparative analysis of the clinical records of 116 patients with sCOVID-19 admitted to the department of critical care medicine of Wuhan Third Hospital from January 1, 2020 to March 31, 2020 and 135 patients with sCAP admitted to the department of critical care medicine of Shanghai First People's Hospital from January 1, 2010 to December 31, 2017 was conducted. The basic information, diagnosis and comorbidities, laboratory data, etiology and imaging results, treatment, prognosis and outcome of the patients were collected. The differences in clinical data between sCOVID-19 and sCAP patients were compared, and the risk factors of death were analyzed.Results:The 28-day mortality of sCOVID-19 and sCAP patients were 50.9% (59/116) and 37.0% (50/135), respectively. The proportion of arterial partial pressure of oxygen/fraction of inspired oxygen (PaO 2/FiO 2)≤250 mmHg (1 mmHg ≈ 0.133 kPa) in sCOVID-19 patients was significantly higher than that of sCAP [62.1% (72/116) vs. 34.8% (47/135), P < 0.01]. The possible reason was that the proportion of multiple lung lobe infiltration in sCOVID-19 was significantly higher than that caused by sCAP [94.0% (109/116) vs. 40.0% (54/135), P < 0.01], but the proportion of sCOVID-19 patients requiring mechanical ventilation was significantly lower than that of sCAP [45.7% (53/116) vs. 60.0% (81/135), P < 0.05]. Further analysis of clinical indicators related to patient death found that for sCOVID-19 patients PaO 2/FiO 2, white blood cell count (WBC), neutrophils (NEU), neutrophil percentage (NEU%), neutrophil/lymphocyte ratio (NLR), total bilirubin (TBil), blood urea nitrogen (BUN), albumin (ALB), Ca 2+, prothrombin time (PT), D-dimer, C-reactive protein (CRP) and other indicators were significantly different between the death group and the survival group, in addition, the proportion of receiving mechanical ventilation, gamma globulin, steroid hormones and fluid resuscitation in death group were higher than survival group. Logistic regression analysis showed that the need for mechanical ventilation, NLR > 10, TBil > 10 μmol/L, lactate dehydrogenase (LDH) > 250 U/L were risk factors for death at 28 days. For sCAP patients, there were significant differences in age, BUN, ALB, blood glucose (GLU), Ca 2+ and D-dimer between the death group and the survival group, but there was no significant difference in treatment. Logistic regression analysis showed that BUN > 7.14 mmol/L and ALB < 30 g/L were risk factors for 28-day death of sCAP patients. Conclusions:The sCOVID-19 patients in this cohort have worse oxygen condition and symptoms than sCAP patients, which may be due to the high proportion of lesions involving the lungs. The indicators of the difference between the death group and the survival group were similar in sCOVID-19 and sCAP patients. It is suggested that the two diseases have similar effects on renal function, nutritional status and coagulation function. But there were still differences in risk factors affecting survival. It may be that sCOVID-19 has a greater impact on lung oxygenation function, inflammatory cascade response, and liver function, while sCAP has a greater impact on renal function and nutritional status.

Objective:To evaluate the 8 th edition of AJCC/UICC staging system for stage Ⅲ nasopharyngeal carcinoma (NPC) by the survival analysis. All patients were treated with intensity-modulated radiotherapy (IMRT). Methods:Among 1351 treatment-na?ve NPC patients who received radiotherapy/chemoradiotherapy in our hospital from December 2008 to October 2014, 742 and 784 cases were classified as clinical stage Ⅲ based on the criteria of the 7 th and 8 th edition of AJCC/UICC staging systems, respectively. These patients were classified into three subgroups according to the 7 th and 8 th edition of AJCC/UICC staging systems: T 3N 0-1 as G 1( n=226, n=245), T 1-2N 2 as G 2( n=180, n=187) and T 3N 2 as G 3( n=336, n=352). The 5-year overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS) and local-regional recurrence-free survival (LRRFS) were analyzed with Kaplan- Meier method. The differences among different groups were evaluated by log-rank test. Results:There were 93.6% patients evaluated by the 8 th AJCC/UICC staging system remained the same cohort with those by the 7 th AJCC/UICC staging system. The 5-year OS, PFS, DMFS and LRRFS of the 8 th and 7 th staging systems were 84.8% and 85.4%, 76.2% and 77.0%, 80.4% and 81.3%, 89.8% and 90.6%, respectively (all P>0.05). The OS, PFS or DMFS significantly differed among three subgroups classified by the 8 th staging system (all P<0.001). In addition, statistical significance was observed between G 1 and G 2, and between G 1 and G 3(both P<0.05), whereas no statistical significance was noted between G 2 and G 3( P=0.183, 0.310, 0.248). Conclusions:The distribution features and clinical endpoints of clinical stage Ⅲ defined by the 8 th AJCC/UICC staging system are similar to those defined by the 7 th AJCC/UICC staging system. The distribution of survival risk significantly differs among different subgroups. N 2 plays a major role in assessing the survival risk of patients with stage Ⅲ NPC. In the era of IMRT plus chemotherapy, the effect of local tumors on clinical prognosis has been diminished. The 8 th AJCC/UICC staging system remains to be further improved.

Objective:To design and implement a network-based quality management system for tumor radiotherapy.Methods:The system consists of B/S framework-based three-layer structures including the application layer, system service layer and data layer. It utilizes Nutz as the development framework to develop web applications, MySQL as the system database, Java programming language for system development, Tomcat as a system application server for project release and IE, Google and other mainstream browsers to achieve client access server functions.Results:The system can support integrated information management and service of quality control institutions at the provincial, municipal and county levels. The functions include procedure management, case management, quality control management, notification announcement, data management and system management, etc. The system has been set up and tested in the cooperation units, and the operation and function are in good condition.Conclusion:The system can support the assessment of online quality control, which is conducive to information analysis and sharing, promotes the standardization and normalization of quality control and improves work efficiency. Case management function can monitor the diagnosis and treatment processes of patients, establish continuous electronic record, deliver rational treatment and rehabilitation guidance plan, which play a pivotal role in the evaluation of tumor radiotherapy.

Objective: To investigate the effect of three-dimensional conformal radiotherapy (3D-CRT) combined with PC chemotherapy (paclitaxel + carboplatin) on non-small cell lung cancer (NSCLC) patients and the serum levels of CA125, tissue inhibitor of metalloproteinase-1 (TIMP-1), serum amyloid A (SAA) and T-lymphocyte subsets. Methods: A total of 100 patients with NSCLC treated in Affiliated Hospital of Guangdong Medical University from May 2015 to December 2017 were selected as the study subjects. They were divided into control group and observation group according to random number table method, with 50 cases in each group. The observation group was treated with 3D-CRT combined with PC chemotherapy, while the control group was treated with PC chemotherapy. The two groups were treated for 4 cycles. The therapeutic effect, serum CA125, TIMP-1, SAA, T-lymphocyte subsets and adverse reactions were compared between the two groups. Results: Four cases were lost to follow-up both in the two groups. The overall response rate in the observation group (43.48%, 20/46) was higher than that in the control group (23.91%, 11/46; χ²=3.941, P=0.047). The serum levels of CA125, TIMP-1 and SAA of the two groups had no significant difference before treatment, and the levels of these indexes decreased after treatment. The serum levels of CA125, TIMP-1 and SAA in the observation group after treatment were (12.31±1.13) U/ml, (275.31±13.69) pg/ml and (47.21±7.21) mg/L, which were lower than those in the control group [(30.36±1.98) U/ml, (320.36±17.23) pg/ml, (65.92±8.36) mg/L], with significant differences (t=53.699, P<0.001; t=13.884, P<0.001; t=11.495, P<0.001). The levels of CD3⁺ , CD4⁺ , CD8⁺ and CD4⁺ /CD8⁺ of the two groups had no significant difference before treatment, and the levels of these indexes decreased after treatment. The levels of CD3⁺ , CD4⁺ , CD8⁺ and CD4⁺ /CD8⁺ in the observation group were (35.27±10.31)%, (20.27±6.72)%, (15.89±3.37)% and 0.91±0.37, which were higher than those in the control group [(30.77±9.27)%, (15.27±5.73)%, (12.02±2.69)% and 0.75±0.39], with significant differences (t=2.201, P=0.030; t=3.840, P<0.001; t=6.087, P<0.001; t=2.019, P=0.047). There were no significant differences in the adverse reactions such as nausea and vomiting [63.04% (29/46) vs. 43.48% (20/46); χ²=3.537, P=0.060], phlebitis [6.52% (3/46) vs. 4.35% (2/46); χ²=0.000, P>0.999], abnormal liver function [6.52% (3/46) vs. 2.17% (1/46); χ²=0.261, P=0.609] and myelosuppression [8.70% (4/46) vs. 6.52% (3/46); χ²=0.000, P>0.999] between the observation group and the control group. Conclusion For patients with NSCLC, 3D-CRT combined with PC chemotherapy can improve the overall response rate, decrease the levels of serum CA125, TIMP-1 and SAA, and improve the immune function of patients. The therapeutic effect is remarkable and the safety is good. The therapeutic scheme is suitable for the treatment of NSCLC.

Objective To compare the dosimetric effects of micro-multileaf collimator (MLC)(2 mm leaf width) and conventional MLC (10 mm leaf width) on inverse intensity-modulated radiotherapy(IMRT) in intracranial stereotactic radiosurgery(SRS). Methods In view of the fact that the micro-MLC has a small open field,30 patients with intracranial tumor with a<10 cm diameter were enrolled in this study. Their inverse dynamic IMRT plans were established using conventional MLC (conventional group) and micro-MLC (micro group) with the same other conditions. The radiation doses to the target volume and the organs at risk (OAR) were compared between the two groups with t test. Results Compared with the conventional group, the micro group had a significantly better dose distribution in the target volume (P=0.019). However, there were no significant differences in D98,D95,D50,and D3between the two groups (P=0.774,0.650,0.170,0.080). The micro group had a 58.7% lower mean homogeneity index and a 20.1% higher mean conformity index than the conventional group (P=0.000). The micro group had significantly lower radiation doses to OAR than the conventional group (P=0.044). The mean Dmeanand Dmaxof the brain stem in the micro group were 10.0% and 8.2%,respectively,lower than those in the conventional group (P=0.768,0.753). The mean Dmeanand Dmax of the right eye and left eye in the micro group were 16.5%,19.3%,21.4%,and 13.4%,respectively,lower than those in the conventional group (P=0.572,0.775 and 0.734,0.630). The mean Dmaxof the left lens, right lens, left optic nerve, right optic nerve, and optic chiasm in the micro group were 50.4%, 24.1%, 38.5%, 27.8%, and 5.7%, respectively, lower than those in the conventional group (P=0.172,0.467, 0.521,0.740,0.899). The PRV100,PRV50,and PRV25of the normal tissue in the micro group were no more than those in the conventional group(P=0.839,0.832,0.972). Conclusions In inverse IMRT in intracranial SRS,micro-MLC is better than conventional MLC because it can improve CI of the target volume and reduce the radiation doses to OAR.

Objective To explore a desirable therapeutic regimen,which is effective,reasonable and practicable for locally advanced nasopharyngeal cancer (LA-NPC) patients in the era of IMRT,with a potential of translating into survival improvement of these patients.Methods Patients presented with stage Ⅲ-Ⅳ B,WHO type Ⅱ or Ⅲ NPC were randomly assigned to receive concurrent chemoradiotherapy (CCRT group) (45 cases) or induction chemotherapy plus radiotherapy alone (IC + RT group) (43 cases),with random number table.IMRT and rapid arc planning were generated in the same treatment planning system for all patients.These two arms received docetaxel plus cisplatin for first cycle of chemotherapy,and cisplatin only for the second cycle.Results Forty-five patients received CCRT and 43 received IC + RT.All the patients completed two cycles chemotherapy.Compared to the CCRT group,the incidence rate of grade 2-4 leukopenia was lower in IC + RT group[67.4 ％ (29/43) vs.86.7 ％ (39/45),x2 =4.628,P =0.031],while the incidence rate of dermatitis,mucositis,neutropenia and fungal infection of oral cavity had no significant differences (all P ＞ 0.05).The tumor response rate (95.3 ％ vs.100.0 ％,P =0.236),2-year overall survival rate (95.5 ％ vs.94.2 ％,P =0.627),2-year progression free survival rate (94.6 ％ vs.88.6 ％,P =0.303),2-year local recurrent free survival rate (97.3 ％ vs.95.5 ％,P =0.951),2-year regional recurrent free survival rate (94.7 ％ vs.96.2 ％,P =0.949),and 2-years distant metastasis free survival rate (93.7 ％ vs.91.5 ％,P =0.454) of the two groups were similar while comparing CCRT to IC + RT group.Conclusion Combined IMRT with TP/DDP regimen,the efficacy of IC + RT is similar to CCRT for LA-NPC.The IC + RT group has less severe leukopenia than CCRT group,which is worth further study.

Objective To analyze the prognostic factors in patients with initially diagnosed bone-only metastatic nasopharyngeal carcinoma (NPC). Methods We collected the data of 68 patients with initially diagnosed bone-only metastatic NPC admitted to The Affiliated Tumor Hospital of Shantou University Medical College from 1997 to 2015. Forty-nine patients received chemoradiotherapy. The Kaplan-Meier method was used to calculate the overall survival rate;the log-rank test was used for univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis. Results The median follow-up was 953 months. The 1-, 2-, 3-, and 5-year overall survival ( OS) rates were 53%, 38%, 21%, and 15%, respectively. The median OS time was 134 months. The univariate prognostic analysis showed that spinal metastases, the number of bone metastases, lactic dehydrogenase level before treatment, the radiotherapy technology and dose for primary tumor, and the short-term outcome of primary tumor were associated with OS ( P=002, 001, 000, 002, 002, 001 ) . The multivariate prognostic analysis showed that ≤3 bone metastases, dose to primary tumor>65 Gy, and intensity-modulated radiotherapy ( IMRT) were favorable prognostic factors for OS ( P=003,002,004) . Conclusions For patients with initially diagnosed bone-only metastatic NPC, active treatment ( IMRT, dose to primary tumor>65 Gy) should be considered for those with ≤3 bone metastases to achieve a complete response of primary tumor.

Background and objective Lung cancer is the leading cancer-related death worldwide.Patients with lung cancer mainly died of tumor metastasis and invasion.Protein kinase CK2 is an ubiquitous sefine/threonine protein kinase and is frequently upregulated in various human tumors.This study aims to explore the effect and molecular mechanism of the invasion and migration of lung adenocarcinoma A549 cells after knock-down of CK2α expression.Methods The pSilencerTM 4.1-siCK2α-eGFP oflentiviral-me-diated shRNA was constructed.The expression of CK2α was knock-downed,and a stable A549 cell line was established.The invasion and migration ofA549 cell line was detected through Transwell and Boyden chamber assays.The protein expression of the PI3K/Akt signaling pathway and mesenchymal-to-epithelial transition (EMT) was evaluated using Westem blot analysis.Results The invasion and migration of A549 cells were significantly inhibited after the knockdown of CK2α expression compared with that in the control group,p-PTEN,Akt,p-Akt473,p-Akt308,p-PDK1,p-c-Raf,and p-GSK-3β were significantly downregnlated,whereas PTEN was upregulated.Moreover,vimentin,β-catenin,Snail,MMP2,and MMP9 were significantly downregnlated after reducing the CK2α expression.Conclusion CK2α might regulate the invasion and migration of A549 cells through the PI3K/Akt/GSK-3β/Snail signaling pathway,which controls EMT in lung adenocarcinoma.