Objective To compare the dosimetric differences in the heart and its substructures between two hybrid plans for hypofractionated whole-breast radiotherapy after breast-conserving surgery in patients with early-stage left-sided breast cancer. Methods A total of 46 patients with early-stage left-sided breast cancer who underwent hypofractionated whole-breast radiotherapy were randomly selected. Two hybrid radiotherapy plans were used, including hybrid intensity-modulated radiotherapy (H_IMRT) and hybrid volumetric-modulated arc therapy (H_VMAT). The heart and its substructures were contoured, including left anterior descending (LAD), left ventricle (LV), right coronary artery (RCA), and right ventricle (RV). The heart and substructure doses, as well as monitor units, were compared between H_IMRT and H_VMAT. Results Both hybrid plans met the clinical requirements. H_IMRT significantly outperformed H_VMAT for the heart (V₁₀, V₃₀, and D_mean), LAD (V₃₀, V₄₀, D_max and D_mean), LV (V₁₀, V₂₀ and D_mean), RCA (D_max, D_mean), and RV (V₅, V₁₀, D_mean) (P < 0.001). Additionally, H_IMRT was significantly superior to H_VMAT for heart V₅, LAD V₂₀, and RV V₂₀ (P = 0.005, 0.035 and 0.037). For LAD (V₁₅, V₄₀) and LV (V₅, V₂₅), H_IMRT was slightly better than H_VMAT, and the difference was not statistically significant. Conclusion Both H_IMRT and H_VMAT hybrid radiotherapy plans are suitable for hypofractionated whole-breast radiotherapy after breast-conserving surgery in patients with early-stage left-sided breast cancer. H_IMRT is slightly better than H_VMAT in dose sparing for the heart and its substructures.

The progressive destruction of condylar cartilage is a hallmark of the temporomandibular joint (TMJ) osteoarthritis (OA); however, its mechanism is incompletely understood. Here, we show that Kindlin-2, a key focal adhesion protein, is strongly detected in cells of mandibular condylar cartilage in mice. We find that genetic ablation of Kindlin-2 in aggrecan-expressing condylar chondrocytes induces multiple spontaneous osteoarthritic lesions, including progressive cartilage loss and deformation, surface fissures, and ectopic cartilage and bone formation in TMJ. Kindlin-2 loss significantly downregulates the expression of aggrecan, Col2a1 and Proteoglycan 4 (Prg4), all anabolic extracellular matrix proteins, and promotes catabolic metabolism in TMJ cartilage by inducing expression of Runx2 and Mmp13 in condylar chondrocytes. Kindlin-2 loss decreases TMJ chondrocyte proliferation in condylar cartilages. Furthermore, Kindlin-2 loss promotes the release of cytochrome c as well as caspase 3 activation, and accelerates chondrocyte apoptosis in vitro and TMJ. Collectively, these findings reveal a crucial role of Kindlin-2 in condylar chondrocytes to maintain TMJ homeostasis.
Aggrecans/metabolism* ; Animals ; Cartilage, Articular/metabolism* ; Chondrocytes/pathology* ; Cytoskeletal Proteins/metabolism* ; Mice ; Muscle Proteins/metabolism* ; Osteoarthritis/pathology* ; Temporomandibular Joint/pathology*

Objective:To study the clinical features and drug resistance profile of neonatal sepsis caused by different species of Klebsiella.Methods:From January 2009 to December 2018, cryopreserved Klebsiella strains from blood culture of neonatal sepsis cases in NICU of our hospital were reactivated. Molecular identification and antimicrobial susceptibility tests were performed. Clinical features, laboratory tests, drug resistance profile and prognosis of these patients were analyzed retrospectively.Results:A total of 29 strains of Klebsiella were reactivated. Molecular identification assigned 22 cases (75.9%) into Klebsiella pneumoniae (Kpn) group and 7 cases (24.1%) into Klebsiella quasipneumoniae (Kqu) group. Gestational age and birth weight of Kpn group were higher than Kqu group [(33.1±3.2) weeks vs. (30.6±0.9) weeks, (1 847±677) g vs. (1 416±121) g] ( P<0.05). Abdominal distension was more common in Kqu group than Kpn group [42.9% (3/7) vs. 4.5% (1/22), P<0.05]. No significant differences existed in the laboratory tests including white blood cell count, platelet count, hypersensitive C-reactive protein and procalcitonin between the two groups ( P>0.05). Kpn was 100.0% sensitive to Cefazolin-Tazobactam and Amikacinto and less sensitive to Imipenem and Cefperazone-Sulbactam, Meropenem and Ertapenem. Kqu was generally more sensitive than Kpn and the sensitivity of Kqu to Imipenem was 100.0%. No significant differences existed of the prognosis between the two groups ( P>0.05). Conclusions:Kpn is the main pathogen of neonatal Klebsiella sepsis. Kqu sepsis is more common in neonates with smaller gestational age and lower birth weight. Abdominal distention is common presenting symptom in Kpn sepsis and sensitive antibiotics should be used early.

Objective To investigate the relationship between 24-hour urinary protein quantification and maternal and neonatal complications in severe preeclampsia. Methods Totally 2305 cases of pregnant women which were diagnosed as severe preeclampsia more than 28 weeks of single pregnancy in 37 hospitals in mainland China were selected from January 1 to December 31, 2011. According to the results of the highest 24 hours urine protein quantitative after admission, the subjects were divided into 3 groups. The group Ⅰ included 590 cases whose 24h urinary protein were 0-2g. There were 843 cases in group Ⅱ whose 24h urinary protein were 2-5g, 872 cases were in group Ⅲ whose 24h urinary protein were more than 5g. The complications of the maternal and neonatal outcome were analyzed among the three groups. Results The incidence of hypoalbuminemia was 14. 8％, the rate of chest /ascites /pulmonary edema / heart failure was 1. 6％, the incidence of renal dysfuction was 0. 6％ and the incidence of placental abruption and HELLP syndrome was 2. 7％ and 3. 0％. There was significant difference in the incidence of hypoalbuminemia among the three groups of which the incidence of groupⅠwas significantly lower than that of group Ⅱ and group Ⅲ (P ＜ 0. 017). The rate of fetal growth restriction, fetal distress and neonatal asphyxia was 3. 3％, 9. 5％, and 1. 1％. The incidence of neonatal body weight, fetal growth restriction and neonatal asphyxia among the three groups were significantly different (P ＜ 0. 05). The body weight of neonatal group was significantly higher than that of group Ⅱ and group Ⅲ (P ＜ 0. 017). The incidence of FGR in group Ⅱ was significantly higher than that in group Ⅲ (P ＜ 0. 017). The rate of neonatal asphyxia in group Ⅰ was significantly lower than that in group Ⅲ (P ＜ 0. 017). There are no significant difference in the incidence of heart failure /pulmonary edema, placental abruption, HELLP syndrome and cesarean section among the three groups. Conclusion 24-hour urinary protein may increase the risk of hypoalbuminemia in pregnant women with severe preeclampsia, but do not increase the risk of heart failure /pulmonary edema, placental abruption and HELLP syndrome. 24-hour urinary protein was associated with severe preeclampsia neonatal body weight, fetal growth restriction, and neonatal asphyxia.

Objective: To assess the effectiveness in optimizing resources and shortening critical children′s waiting time in pediatric emergency department (PED) with five-level pediatric emergency triage system (PETS). Methods: This retrospective study was conducted in the First Affiliated Hospital of Xiamen University after PETS was applied. The data of patients who visited the pediatric emergency department from January 2015 to December 2017 were collected and analyzed, including age, sex, diseases, visiting time, triage rate and destination. Results: A total of 375 985 patients were included, among whom males were 225 308 (59.9%) and females were 150 677 (40.1%), all younger than 14 years of age. The number of critical cases (level Ⅰ, level Ⅱ and level Ⅲ) was increased from 4 719 (3.7%) in 2015, 12 209 (10.2%) in 2016 to 16 188 (12.7%) in 2017. The number of non-critical patients (level Ⅴ) decreased year by year, as from 98 213 (76.8%) in 2015 to 75 210 (62.6%) in 2016 and 78 857 (61.7%) in 2017. The patients who classified as level Ⅰ or levelⅡaccording to the PETS were seen immediately by physician (n=1855, 0.5%). Overall, 119 738 patients (98.3%) who were classified as level Ⅲ or level Ⅳ could be seen by physician in a timely manner according to triage guidelines, while 2 112 patients (1.7%) could not. The mean waiting time was 9.09 min in level Ⅲ, 17.7 min in level Ⅳ, and 55.76 min in level Ⅴ patients, respectively. The critical cases admitted to the intensive care units were 175 (36.2%) in 2015, 350 (62.8%) in 2016 and 374 (66.2%) in 2017. The etiologies were respiratory diseases (73.3%), gastrointestinal diseases (15.8%) and infectious diseases (3.1%). Conclusion The application of PETS could optimize emergency resources and shorten the waiting time of critically ill children.

Objective In this prospective study,the performance between high-resolution diffusion-weighted imaging ( DWI) and diffusion kurtosis imaging ( DKI) for prediction of radiotherapy response in patients with nasopharyngeal carcinoma was compared. Methods Forty-one patients pathologically diagnosed with NPC received IMRT. All patients underwent conventional MRI,high-resolution DWI and DKI before and after radiotherapy (1-2 d after the plan dose was administered).All patients received conventional MRI during follow-up at 3,6,9 and 12 months after radiotherapy. According to the RECIST 1. 1( response evaluation criteria in solid tumors),all patients were divided into the response group (RG;n＝36) and non-response group (NRG;n＝5). The mean kurtosis coefficient (Kmean) and the mean diffusion coefficient (Dmean) of DKI and apparent diffusion coefficient ( ADC) of DWI were analyzed before and after radiotherapy. Results Among 41 patients,36 cases were assigned into the RG group and 5 in the NRG group. Before and after radiotherapy, all parameters significantly differed between two groups ( P＝0. 000-0. 013) except for the Dmeanand ADC prior to radiotherapy. At the end of radiotherapy,the sensitivity of Kmeanwas calculated as 87. 5% and the specificity was 91. 3% for predicting local control (optimal threshold＝0. 30, AUC: 0. 924; 95%CI: 0. 83-1. 00 ). Conclusion Kmeanvalue after radiotherapy is a potential biomarker for the early evaluation of clinical efficacy of radiotherapy in NPC patients.

Objective To investigate the dynamic changes of blood-brain barrier(BBB) permeability after acute cerebral ischemia in rats with middle cerebral artery occlusion (MCAO) by dynamic contrast-enhanced(DCE)-MRI. Methods Sixty MCAO rat models were established by suture-occlusion method. All rats were divided randomly into twelve groups with different ischemia duration (3 hours, 6 hours, permanent) and reperfusion times (2, 6, 12 and 24 hours after reperfusion). Each group was examined by MRI at the time points. The BBB permeability parameters(Ktrans, Ve, Kep, rKtrans, rVe, rKep) were calculated by Siemens workstation and compared with Evans blue(EB) extravasation results. Multivariate analysis of variance (M-ANOVA), one-way analysis of variance (one-way ANOVA), Pearson analysis were respectively used to verify the influences of ischemia duration and reperfusion time on BBB permeability parameters, EB extravasation and relationships between parameters. Results In 3 hours and 6 hours ischemia duration groups, change of BBB permeability after reperfusion appeared biphasic. At 2 hours and 6 hours after reperfusion, BBB permeability increased, while rKtrans values and rVe values rose and rKep values dropped. BBB permeability decreased at 12 hours and increased again at 24 hours after reperfusion. The highest BBB permeability was observed at 6 hours after reperfusion. However, BBB permeability in permanent ischemia groups had uniphasic change, as its increase was rather mild as ischemia time went on. rKtrans values(1.99± 0.79)were positively correlated with rVe values(2.88 ± 1.78) (r=0.93, P<0.01) and negatively correlated with rKep values(0.66 ± 0.21) (r=-0.84, P<0.01). The negative correlation between rVe values and rKep valueswas also significant(r=- 0.80, P<0.01). EB extravasation results were consistent with MRI findings. Conclusions BBB permeability change was biphasic in reperfusion groups, while it was uniphasic in permanent ischemia groups. DCE-MRI may accurately reflect the changes of BBB permeability after acute cerebral ischemia. Both ischemic duration and reperfusion time had influences on BBB permeability. With prolongation of ischemic time, the duration of BBB permeability increase became shorter, BBB damage appeared earlier, with increased degree of ischemic damage.

Objective To explore the association between maternal age and perinatal outcomes.Methods Totally,3 151 women with advanced maternal age and 6 098 women younger than 35 years old who delivered in Beijing Obstetrics and Gynecology Hospital in 2016 were recruited.Their clinic characteristics and perinatal outcomes were collected to divide into 3 groups based on delivery age,Group 1 (aged 35-39 years,2 683 cases),Group 2 (aged ≥40 years,366 cases) and the control group (aged＜35 years,6 098 cases).The association between maternal age and adverse perinatal outcomes were analyzed,including hypertensive disorder complicating pregnancy,gestational diabetes mellitus (GDM),preterm birth and postpartum hemorrhage.Results The rate of cesarean section history (27.39％,33.61％,5.53％) or previous myomectomy history (2.80％,5.46％,0.72％) were compared between the advanced maternal age groups and the control group,and the differences were statistically significant (P＜0.05).The percentage of prepregnancy overweight and obesity (29.67％,27.05％,18.47％),complicated with myoma (14.83％,19.95％,5.64％) were compared among the three groups,and the differences were statistically significant (P＜ 0.05).The percentage of pregnancy through assisted reproductive technology (9.84％,15.03％,3.12％) also had statistically significant differences (P＜0.05).The incidence of fetal chromosomal abnormalities (1.23％,3.01％,0.36％) and fetal malformations (1.94％,4.37％,0.48％) increased with the maternal age,with statistically significant differences (P＜0.01).The mobidity of hypertensive disorders (9.84％,13.11％,9.23％),pregestational diabetes mellitus (1.83％,2.19％,0.72％),gestational diabetes mellitus (22.70％,28.42％,14.87％),premature rupture of membranes (25.57％,19.40％,31.42％),placenta previa (2.05％,2.46％,0.92％),preterm birth(8.35％,11.20％,5.51％),postpartum hemorrhage (25.11％,18.31％,20.27％)and forceps delivery (5.42％,2.33％,5.71％) were compared,and the differences were statistically significant (P＜0.05).The cesarean section rate in primipara (45.42％,75.74％,21.33％) and multipara (51.46％,61.54％,30.95％) had statistically significant difference (P＜0.05).The proportion of macrosomia (10.80％,8.85％,7.96％) and neonates transferred into neonatal ICU (9.63％,11.48％,5.21％) in term neonates had statistically significant difference (P＜0.05).Conclusions Women with advanced maternal age increase after new family planning policy put into effect,so do the risk of adverse perinatal outcomes.Attention and interventions should be made to cope with the occurrence of adverse perinatal outcomes.

Objective To analyze the pathogens distribution and drug resistance of nosocomial infection in patients with end-stage diabetic nephropathy .Methods 96 cases of end-stage diabetic nephropathy were randomly selected in our hospital .The speci-mens of urine ,blood and sputum were collected .The pathogens were identified by the drug susceptibility testing .Results The in-fection rate was 27 .08% .A total of 103 strains of pathogens were isolated ,including 15 strains of fungi ,42 strains of gram-negative bacteria and 46 strains of gram-positive bacteria .The drugs susceptibility rates of the fungi to flucytosine ,amphotericin B and flu-conazole were 100% ,and it also showed that the fungi had higher sensitivity to other common antibiotics ;the drug susceptibility rates of gram-positive bacteria to vancomycin and teicoplanin were 100% ,while its drug susceptibility ability to penicillin ,strepto-mycin and others were weak ;the drug susceptibility rates of gram-negative bacteria to piperacillin and imipenem were high ,while its drug susceptibility ability to aztreonam and cephalosporin were weak .Conclusion The low resistance in the patients with end-stage diabetic nephropathy the abuse of clinical antiseptic drugs lead to the dysbacteriosis ,resulting in a significant increase of the inci-dence of nosocomial infection ,so the analysis of pathogens distribution and drug resistance of nosocomial infection has clinical sig-nificance .

Objective To investigate the factors affecting the vaginal birth after cesarean (VBAC). Methods Totaly 298 women who underwent trial of labor after cesarean section (TOLAC) from Jan 2015 to Dec 2015 were recruited from Beijing Obstetrics and Gynecology Hospital, FuXing Hospital, Tongzhou Maternal and Child Health Hospital of Beijing, the Second Affiliated Hospital of Chongqing Medical University and the People′s Hospital of Chengyang District of Qingdao. The maternal age, the interval from the last cesarean section, the body mass index (BMI) before pregnancy, the weight gain during pregnancy, the way into labor, the Bishop score before labor, the gestational age and the birth weight of the neonate were recorded in a self-made form. The factors affecting VBAC were analyzed by univariate analysis and multivariable logistic regression. Results (1)The incidence of VBAC, uterine rupture, postpartum hemorrhage and neonatal asphyxia were 70.5%(210/298), 2.7%(8/298), 9.4% (28/298) and 1.3% (4/298), respectively. No maternal death and perinatal death occurred. (2)The univariate analysis suggested that the maternal age, the BMI before pregnancy, the Bishop score before labor, the labor induction, the gestational age at delivery and the neonatal weight were factors affecting VBAC. The maternal age and the Bishop score before labor were significantly higher in the VBAC group than in the unsuccessful TOLAC group(P<0.05). While the BMI before pregnancy, the induction rate, the gestational weeks at delivery and the birth weight of the neonate were significantly lower in the VBAC group than in the unsuccessful TOLAC group (P<0.05). Multivariable logistic regression analysis showed that successful VBAC was affected by the maternal age, the BMI before pregnancy, the Bishop score before labor and the birth weight of the neonates(P<0.05). Conclusion The maternal age, the BMI before pregnancy, the Bishop score before labor and the birth weight of neonate are the main factors affecting VBAC.