For a long time, macrolides have been the first choice for the antibacterial treatment for pertussis.However, in the past decade, resistance to macrolide antimicrobials has been common in clinically isolated Bordetella pertussis in China, which is in contradiction with the recommended macrolide treatment.Therefore, Trimethoprim-Sulfamethoxazole (TMP-SMZ) is suggested as the first choice for antibacterial treatment for pertussis in China, with a dosage determined according to age and body weight, lasting 14 days.If TMP-SMZ cannot be used, full-dose and full-course β-lactam antimicrobials may be used, of which the effects should be assessed carefully.The impact of other antibacterial drugs, such as quinolones and tetracyclines, on the elimination of Bordetella pertussis should also be evaluated as soon as possible to treat adult pertussis and potential cases caused by drug-resistant bacteria in future.

Objective:To evaluate the effectiveness and safety of concurrent chemoradiotherapy combined with nimotuzumab in the treatment of patients with inoperable esophageal squamous cell carcinoma (ESCC).Methods:A retrospective analysis was conducted on the clinical data of 503 patients with inoperable ESCC who underwent concurrent chemoradiotherapy in the Department of Radiation Oncology, Changzhou No. 2 People′s Hospital Affiliated to Nanjing Medical University and Department of Radiation Oncology, Affiliated Hospital of Jiangnan University from 2014 to 2020. Among these patients, 69 received concurrent chemoradiotherapy combined with nimotuzumab (the combined therapy group) and 434 received concurrent chemoradiotherapy alone (the concurrent chemoradiotherapy group). Patients of both groups were matched at a ratio of 1∶2 using the propensity score matching (PSM) method. As a result, 168 patients were determined for clinical analysis, including 61 in the combined therapy group and 107 in the concurrent chemoradiotherapy group. The short-term efficacy and adverse reactions of both groups were compared. The overall survival (OS) curves and progression-free survival (PFS) curves were plotted using the Kaplan-Meier method for the Log-rank test.Results:The two groups showed no statistical difference ( P > 0.05) in clinical baseline characteristics after the PSM. The objective response rate (ORR) of the combined therapy group was significantly higher than that of the concurrent chemoradiotherapy group with statistically significant differences (85.2% vs. 71.0%, χ2 = 4.33, P = 0.037). There was no statistical difference (98.4% vs. 91.6%, P > 0.05) in the disease control rate (DCR) between the two groups. The combined therapy group had median PFS of 28.07 months and 1-, 3-, and 5-year PFS ratios of 78.2%, 37.5% and 29.1%, respectively. The concurrent chemoradiotherapy group had mPFS of 19.54 months and 1-, 3-, and 5-year PFS ratios of 72.9%, 28.3% and 21.3%, respectively. Both groups showed statistically significant differences in PFS ( χ2 = 4.49, P = 0.034). The combined group had median OS of 34.93 months and 1-, 3-, and 5-year OS ratios of 88.5%, 46.8% and 37.4%, respectively. The concurrent chemoradiotherapy group had mOS of 24.30 months and 1-, 3-, and 5-year OS ratios of 81.3%, 35.2% and 28.0%, respectively. Both groups showed statistically significant differences in OS (χ 2= 5.11, P = 0.024), but did not show statistical differences ( P > 0.05) in the severity degree of each adverse effect during the treatment. Conclusions:Concurrent chemoradiotherapy combined with nimotuzumab can improve the ORR and prolong the PFS and OS of patients with inoperable ESCC compared with concurrent chemoradiotherapy alone. Furthermore, combining with nimotuzumab does not increase adverse effects and can be tolerated by patients with high safety.

Objective:To study the effects of poly adenosine diphosphate ribose polymerase (PARP) inhibitors niraparib and pamiparib on the radiosensitivity of breast cancer cell lines MCF-7 and MDA-MB-436, and to explore its mechanism.Methods:MCF-7 and MDA-MB-436 cells were divided into control group, niraparib group, pamiparib group, radiation group, combination group treated with niraparib and radiation, and combination group treated with pamiparib and radiation, respectively. The effects of drugs on cell proliferation and radiosensitivity were measured by CCK-8 assay and colony formation assay, respectively. The effect of drugs combined with radiation on cell cycle and apoptosis were detected by flow cytometry. Immunofluorescence method was used to detect the changes of γ-H2AX focal number of cells. The expressions of FANCG, Bax and Bcl-2 mRNA and protein were detected by qPCR and Western blot, respectively.Results:Both niraparib and pamiparib inhibited the proliferation of breast cancer cells MCF-7 and MDA-MB-436 in a time-dose dependent manner. With the increase of irradiation dose, D0, Dq, SF2 value of MCF-7 and MDA-MB-436 cells decreased, and SER D0 and SER Dq value increased. Compared with control group, the percentages of cells in G 2/M phase were increased ( tMCF-7=41.66, 44.08, P<0.05; t436=24.69, 18.91, P<0.05), the percentage of cells in G 0/G 1 phase were decreased ( tMCF-7=8.67, 29.61, P<0.05; t436=26.39, 29.12, P<0.05), and the cell apoptosis rate was significantly increased ( tMCF-7=11.17, 11.71, P<0.05; t436=42.68, 15.89, P<0.05) in the combination group. Compared with control group, the number of γ-H2AX foci of MCF-7 cells in the radiation group and combination group treated with niraparib and radiation increased significantly at 2 h after irradiation ( t=8.89, 21.72, P<0.05). At 24 h after irradiation, the number of γ-H2AX foci basically returned to normal level in the radiation group but remained at a higher level in the combination group ( t=8.82, P<0.05). Compared with control group, the expressions of FANCG and Bcl-2 mRNA decreased ( tFANCG=14.07, P<0.05; tBcl-2=29.21, P<0.05), the expression of Bax mRNA increased ( t=8.90, P<0.05), and the expression of FANCG and Bcl-2 proteins decreased ( tFANCG=7.09, P<0.05; tBcl-2=10.24, P<0.05), while the expression of Bax protein increased ( t=2.90, P<0.05) in the combination group. Conclusions:PARP inhibitors niraparib and pamiparib can increase the radiosensitivity of breast cancer MCF-7 and MDA-MB-436 cells probably through down-regulating the expression of FANCG in FA-BRCA pathway, up-regulating apoptosis-related genes and inhibiting DNA damage repair.

Objective:To evaluate the antibacterial activity of pediatric Faropenem sodium against common pathogens isolated from children′s respiratory tract in vitro, and to provide reference for its clinical research and application. Methods:Retrospective analysis.The minimum inhibitory concentration (MIC) of Faropenem sodium, Merope-nem, Imipenem and other antibiotics was determined by the agar dilution method.A total of 156 strains of Streptococcus pneumoniae [including 32 strains of Penicillin-susceptible Streptococcus pneumoniae (PSSP), 28 strains of Penicillin-intermediate Streptococcus pneumoniae (PISP) and 96 strains of Penicillin-resistant Streptococcus pneumoniae (PRSP)], 98 strains of Haemophilus influenza, 173 strains of Klebsiella pneumoniae, and 55 strains of Moraxella catarrhali clinical isolates were used.MIC 50, MIC 90 and the accumulative inhibition of the bacteria were investigated. Results:The MIC of Faropenem sodium against all the Streptococcus pneumoniae strains ranged from 0.010-2.000 mg/L.There was no difference in the MIC distribution of Faropenem sodium against PSSP, PISP and PRSP, and the MIC 90 value was all 1.000 mg/L.Faropenem sodium inhibited all the Haemophilus influenza strains at concentrations ranging from 0.030-8.000 mg/L.There was no difference in the MIC distribution of Faropenem sodium against Haemophilus influenza with or without β-lactamase and Ampicillin resistance.The MIC 90 value was all 4.000 mg/L.Ho-wever, the MIC of Faropenem sodium against Klebsiella pneumoniae ranged from 0.250 to above 32.000 mg/L, and both MIC 50 and MIC 90 were greater than 32.000 mg/L.Faropenem sodium inhibited all the Moraxella catarrhalis strains at concentrations ranging from 0.030-2.000 mg/L, with MIC 50 being 0.500 mg/L and MIC 90 being 1.000 mg/L. Conclusions:Antimicrobial susceptibility testing results in vitro demonstrate that pediatric Faropenem sodium has satisfactory antibacterial activities against Streptococcus pneumoniae, Haemophilus influenza, and Moraxella catarrhalis, but comparatively weak antibacterial activities against Klebsiella pneumoniae.

Objective:To assess the influence of an artificial intelligence (AI) -assisted diagnosis system on the performance of endoscopists in diagnosing gastric cancer by magnifying narrow banding imaging (M-NBI).Methods:M-NBI images of early gastric cancer (EGC) and non-gastric cancer from Renmin Hospital of Wuhan University from March 2017 to January 2020 and public datasets were collected, among which 4 667 images (1 950 images of EGC and 2 717 of non-gastric cancer)were included in the training set and 1 539 images (483 images of EGC and 1 056 of non-gastric cancer) composed a test set. The model was trained using deep learning technique. One hundred M-NBI videos from Beijing Cancer Hospital and Renmin Hospital of Wuhan University between 9 June 2020 and 17 November 2020 were prospectively collected as a video test set, 38 of gastric cancer and 62 of non-gastric cancer. Four endoscopists from four other hospitals participated in the study, diagnosing the video test twice, with and without AI. The influence of the system on endoscopists′ performance was assessed.Results:Without AI assistance, accuracy, sensitivity, and specificity of endoscopists′ diagnosis of gastric cancer were 81.00%±4.30%, 71.05%±9.67%, and 87.10%±10.88%, respectively. With AI assistance, accuracy, sensitivity and specificity of diagnosis were 86.50%±2.06%, 84.87%±11.07%, and 87.50%±4.47%, respectively. Diagnostic accuracy ( P=0.302) and sensitivity ( P=0.180) of endoscopists with AI assistance were improved compared with those without. Accuracy, sensitivity and specificity of AI in identifying gastric cancer in the video test set were 88.00% (88/100), 97.37% (37/38), and 82.26% (51/62), respectively. Sensitivity of AI was higher than that of the average of endoscopists ( P=0.002). Conclusion:AI-assisted diagnosis system is an effective tool to assist diagnosis of gastric cancer in M-NBI, which can improve the diagnostic ability of endoscopists. It can also remind endoscopists of high-risk areas in real time to reduce the probability of missed diagnosis.

Objective: To investigate the adverse effects and clinical efficacy of the intensive modulated radiotherapy(IMRT)and intravaginal brachytherapy combined with versus without chemotherapy in elderly patients with cervical cancer, and to analyze its prognostic factors. Methods: Clinical data and follow-up results of 214 patients with cervical cancer aged ≥60 years undergoing IMRT and intravaginal brachytherapy combined with or without chemotherapy were retrospectively analyzed.The overall survival(OS)rate was calculated by using the Kaplan-Meier method.Prognostic factors were analyzed by Log-rank single factor test and Cox multivariate analysis. Results: The rates of myelosuppression(≥grade 3)was higher in the concurrent chemo-radiotherapy group than in simple radiotherapy group(48.6% vs.15.8%, χ²=27.372, P<0.05). The complete response(CR)rate was higher in the concurrent chemo-radiotherapy group than in the simple radiotherapy group(83.0% vs.68.3%, χ²=5.993, P=0.014). The 1-, 3- and 5-year OS rate were 92.2%, 79.3% and 65.6%, respectively in all patients.Univariate analysis showed that the staging, lymph node metastasis status, pathological type and short-term efficacy of cervical cancer(based on FIGO guideline)were influencing factors for the prognosis(χ²=4.321-30.316, all P<0.05). Multivariate analysis showed that the FIGO staging, lymph node metastasis status and short-term efficacy were independent influencing factors for the prognosis(χ²=5.284-14.261, all P<0.05). Conclusions The intensive modulated radiotherapy and intravaginal brachytherapy combined with chemotherapy have a good efficacy and favorable long-term survival rate for the treatment of cervical cancer in elderly patients, and its major adverse effects can be tolerated.The FIGO staging, lymph node metastasis status and short-term efficacy are independent influencing factors for the prognosis in elderly patients with cervical cancer.

Objective: To investigate the adverse events and efficacy in cervical cancer patients receiving intensity modulated radiationtherapy (IMRT) plusbrachytherapy with or without chemotherapy, and to indentify the factors that may affect the prognosis. Methods: In this retrospective analysis, we analyzed the clinical and follow-up data of the 422 cervical cancer patients, who received IMRT plus brachytherapy with or without chemotherapy.Among these patients, 353 cases received concurrent chemoradiotherapy and the other 69 cases received radiotherapy alone. Kaplan-Meier method was utilized to calculate the overall survival (OS) rates. Log-rank-test and Cox regression were performed to executing the univariate and multivariate analysis of the OS, respectively. Results: The rate of complete response (CR) in the patients receiving concurrent chemoradiotherapy was significantly higher than that of the patients who received single radiotherapy (77.6% vs. 65.2%, χ²=4.812, P<0.05). The 1-, 3-, and 5-year OS rates were 93.4%, 79.4%, and 65.0%, respectively. Univariate analysis showed that age, Federation International of Gynecology and Obstetr(FIGO)2009 staging, lymph node metastasis, pathological type, chemotherapy experiences concurrent with radiotherapy, short-term efficiency, and sequential chemotherapy could affect the OS (χ²=6.375-613.123, P<0.05). Multivariate analysis showed that FIGO staging, lymph node metastasis, pathological type, chemotherapy experiences concurrent with radiotherapy, and the short-term efficacy were the independent determinants for the prognosis (χ²=3.930-42.994, P<0.05). For patients with positive pelvic lymph node, there were no statistical differences in the para-aortic lymph node (PALN) metastasis whether undergoing prophylactic extended field irradiation of the PALN or not(PALN metastasis rates: 6.1% vs. 16.8%, P>0.05). The OS for the patients receiving prophylactic extended field irradiation of the PALN was higher than that of patients without prophylactic radiation (χ²=3.953, P<0.05). Conclusions Cervical cancer patients receiving IMRT plus brachytherapy with or without chemotherapy had achieved promising prognosis. Prophylactic extended field irradiation of the PALN contributed to the improved OS in the patients with pelvic lymph node metastasis. FIGO staging, pathology type, lymph node metastasis, radiotherapy concurrent with chemotherapy or not, and short-term efficiency were independent factors for the prognosis.

Objective To investigate the effect of high-flow nasal cannula oxygen therapy (HFNC) on the clinical efficacy and diaphragm function of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The patients with mild to moderate AECOPD (clinical classification Ⅰ-Ⅱ) admitted to Huxi Hospital Affiliated to Jining Medical College from January to October in 2018 were enrolled. The patients were divided into HFNC treatment group and routine oxygen therapy control group (each n = 37) by randomly number table method. The two groups were given bronchiectasis drugs, corticosteroids, expectorant, anti-infection treatment, at the same time, the HFNC treatment group was given HFNC with the initial flow rate of 40 L/min. The routine oxygen therapy control group was given low flow oxygen, and the initial flow rate was 3 L/min. General data such as gender, age, clinical grade, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score were recorded. Bedside ultrasound was used to measure the diaphragmatic excursions during quiet breathing (DEq), diaphragmatic excursions during deep breathing (DEd), and diaphragmatic shallow fast breathing index (D-RSBI) before and 2, 24 and 48 hours after treatment in both groups and compared, meanwhile, arterial blood gas analysis was performed, and arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were recorded. Results Two patients in the HFNC treatment group withdrew from the study because they could not tolerate HFNC, while other patients were enrolled in the analysis. There was no statistically significant difference in gender, age, proportion of AECOPDⅡ grade or APACHEⅡscore between the two groups, indicating that the general data of the two groups were comparable and balanced. There was no statistically significant difference in DEq, DEd, D-RSBI, PaO2 or PaCO2 before treatment between the two groups. After treatment, DEp in both groups was decreased gradually with time, it was decreased earlier in the HFNC treatment group, and it showed significant difference as compared with that before treatment at 2 hours after treatment (mm: 18.3±3.1 vs. 20.1±4.2, P < 0.01), and it was significantly lower than that in the routine oxygen therapy control group (mm: 18.3±3.1 vs. 20.3±3.7, P < 0.05); DEd was gradually increased in both groups, it was significantly increased in the HFNC treatment group, and it was significantly higher than that in the routine oxygen therapy control group at 24 hours and 48 hours after treatment (mm: 55.2±7.6 vs. 50.8±9.2 at 24 hours, 59.4±7.7 vs. 53.6±9.1 at 48 hours, both P < 0.05); D-RSBI was decreased gradually in both groups, it was decreased earlier and more significant in the HFNC treatment group, and it was significantly lower than that in routine oxygen therapy control group at 24 hours and 48 hours after treatment (times·min-1·mm-1: 0.41±0.13 vs. 0.51±0.20 at 24 hours, 0.31±0.12 vs. 0.43±0.17 at 48 hours, both P < 0.05). After treatment, there was no statistically significant difference in PaO2 or PaCO2 between the two groups. Conclusion HFNC can effectively relieve diaphragm fatigue in patients with mild to moderate AECOPD, but it had no effect on carbon dioxide retention.

Objective To analyze the correlation between function of liver and kidney and blood lipid inde-xes and the prognosis of acute cerebral infarction.Methods 100 patients with acute cerebral infarction were selected.Serum levels of uric acid (UA),serum creatinine (Scr),serum triglyceride (TG),total cholesterol (TC),low density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C),and blood calcium (Ca2+).Fasting blood glucose (FPG),fibrinogen (FIB),D two polymer (D-D),serum homocysteine (Hcy),total bilirubin(TBIL),direct bilirubin (DBIL),and indirect bilirubin (IBIL)UA,Scr,TG,TC,LDL-C, HDL-C,Ca2+,FPG,FIB,D-D,Hcy,TBIL,DBIL and IBIL were measured in all the patients the next morning after admission.According to the CSS score,the patients were divided into mild group (0 -15 points,35 ca-ses),medium group (16~30 pointsminutes,34 cases),heavy group 3(31~45 pointsminutes,31 cases).The NIHSS score difference betweenin the scores of the two patients at admission and three months after the onset of the disease was calculated.The patients were divided into the improved group(score difference >0 points, 58 cases),no change group (score difference = 0,36 cases) aAnd worsening group(score difference < 0 point,6 cases).The levels of serum UA,Scr,TG,TC,LDL-C,HDL-C,Ca2+,FPG,FIB,D-D,Hcy,TBIL, DBIL,IBILof different severity and different prognosis of patients were compared and the relevance were ana-lyzed.Results The levels of UA,Hcy,FIB,DD and,LDL-C were the highest in the heavy group and the low-est in the light group.The levels of Ca2+,TBIL,DBIL and IBIL were the lowest in the heavy group,and the highest in the light group.The differences of above indexes between the three groups were statistically signifi-cant (P<0.05).There were positive correlations between the severity of the disease with serum levels of UA, Hcy,FIB,D-D and LDL-C (P<0.05),and a negatively correlations with serum levels of Ca2+,TBIL,DBIL and IBIL (P<0.05).The levels of UA,Hcy,and LDL-C were the highest in the worsening group and the low-est in the improved group,the levels of TBIL,DBIL and IBIL were the lowest in the worsening group and the highest in the improved group.The differences between the three groups were statistically significant (P<0. 05).The prognosis was positively correlated with serum levels of UA,Hcy and LDL-C (P<0.05),and nega-tively correlated with serum levels of TBIL,DBIL and IBIL(P<0.05).Conclusion The serum levels of UA, Hcy,FIB,D-D,LDL-C,Ca2+,TBIL,DBIL and IBIL were significantly correlated with the severity of acute cer-ebral infarction.The serum levels of UA,Hcy,LDL-C,TBIL,DBIL and IBIL were also correlated with pro-longed prognosis.

Objective To assess the long-term efficacy and adverse effects of three-dimensional radiotherapy (3-DCRT) for elderly patients with esophageal cancer,to investigate the effects of diabetes and hypertension on radiation esophagitis and pneumonitis and to analyze the prognostic factors.Methods A total of 233 patients aged 70 or over with esophageal squamous cell carcinoma were treated with 3-DCRT,and 27 of the patients had type-2 diabetes and 63 had hypertension.Radiation esophagitis and pneumonitis were monitored in patients with or without diabetes and in patients with or without hypertension.Potential prognostic factors were analyzed by Logrank single factor analysis and Cox multivariate analysis.Results The incidences of radiation esophagitis and pneumonitis in grade 3 or over were significantly higher in patients with diabetes than in those without diabetes (Z =-3.762,-2.972;P ＜0.001,0.003).The incidences of radiation esophagitis and pneumonitis in grade 3 or over in patients with hypertension were significantly higher than in those without hypertension (Z =-2.610,-2.209;P =0.009,0.027).The 1-,3 and 5-year overall survival (OS) rates were 70.6％,35.8％ and 23.9％,respectively.The median OS was 23.0 months (95％CI:18.6-27.5).Univariate analysis showed that age (x2 =4.274,P =0.039),T stage (x2=9.376,P 0.025),N-stage (x2=8.504,P=0.014),TNM stage (x2=7.806,P=0.020),gross tumor volume (GTV) (x2 =5.209,P =0.022) and short-term therapeutic efficacy (x2 =25.276,P＜0.001) had influenced OS.Multivariate analysis showed that T-stage (P =0.001),N-stage (P =0.007),TNM stage (P =0.002) and short term therapeutic efficacy (P ＜ 0.001) were independent prognostic factors for OS.Conclusions 3-DCRT achieves favorable long-term efficacy in elderly patients with esophageal cancer.Diabetes and hypertension are potential risk factors for radiation esophagitis and pneumonitis.T-stage,N-stage,TNM stage,and short term therapeutic efficacy are independent prognostic factors.