ABSTRACT
Objective:To analyze the clinical characteristics of community acquired pneumonia in hospitalized children with infectious exanthems and to accumulate clinical experience in the diagnosis and treatment.Methods:The data of the community acquired pneumonia patients with infectious exanthems in Oingdao Women and Children′s Hospital were collected retrospectively from September 2013 to August 2020 and the clinical characteristics were analyzed.Results:A total of 455 cases were included, and there were 273 boys(60.0%)and 182 girls(40.0%). A total of 106 cases were grouped into the severe group(23.3%)and 349 cases were grouped into the non-severe group(76.7%). The median age was 16.0(9.0, 42.0)months.The exanthems occurred in day(6.9±5.2)d after the beginning of pneumonia.The duration of exanthems was(6.0±3.1)days.The exanthems was polymorphic and non-specific.The detection rate of influenza B virus was highest, including 91 cases(20.0%), followed by 85 cases of MP infection(18.7%), 50 cases(11.0%)of EBV reactivation infection.The median age, hospitalization time, fever time, exanthems appearance time, exanthems duration and the rate of the rash appears in the second fever course, CRP elevation, PCT elevation, IgE elevation, MP infection and reactivation of EB virus in the severe group were higher than those of non-severe group, and the differences were statistically significant( U=13 467.0, t=6.500, 4.923, 3.098, 2.998, χ2=13.445, 15.391, 8.208, 5.313, 29.839, 13.474, P<0.05). Multivariate logistic analysis showed that poor general conditions, extrapulmonary complications, decreased respiratory tone and recurrent fever accompanied by exanthems were independent risk factors. Conclusion:A non-specific infective rash associated with the course of the hospitalized CAP has some implications for the assessment of severity and etiology.
ABSTRACT
Objective:To evaluate the efficacy of intensity-modulated radiation therapy (IMRT) combined with chemotherapy for treating patients with T 1-2N 1M 0 nasopharyngeal carcinoma (NPC). Methods:343 patients diagnosed with T 1-2N 1M 0 NPC in Zhejiang Cancer Hospital and Sun Yat-sen University Cancer Center from January 2008 to December 2016 were recruited in this study. All patients received IMRT and divided into the radiotherapy (RT) and chemoradiotherapy (CRT) groups. Patients in the CRT group were further assigned into the concurrent chemoradiotherapy (CCRT), induction chemotherapy+ CCRT (IC+ CCRT) and CCRT+ adjuvant chemotherapy (AC) groups. Locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS) were estimated by Kaplan- Meier method. Multivariate prognostic analysis was performed by Cox models. Results:The median follow-up time for surviving patients (303/343) was 91(range: 49-138) months. The 5-year OS, CSS, PFS, LRFFS, and DMFS rates in the CRT group were not superior to those of the RT group (93.7%: 93.9%, 93.7%: 93.9%, 89.0%: 87.7%, 93.8%: 92.8%, 93.8%: 91.2%, all P>0.05). No significant difference was found in treatment outcomes of patients with T 1N 1 or T 2N 1 NPC between two groups (all P>0.05). In multivariable analyses, only age was an independent prognostic factor for OS, PFS, CSS and DMFS, and negative correlation was found between them. No survival benefits were achieved in the CCRT, IC+ CCRT, CCRT+ AC and RT groups, and no significant differences were found in clinical efficacy among the three combined (all P>0.05). Conclusions:IMRT alone yields comparable clinical efficacy to CRT in treating patients with T 1-2N 1M 0 NPC. However, whether CT can be eliminated in the T 1-2N 1M 0 population still needs further confirmation by prospective, randomized and controlled clinical trials.
ABSTRACT
Objective@#To evaluate the value of two oral mucosal contouring methods for predicting acute radiation-induced oral mucositis (A-ROM) in nasopharyngeal carcinoma (NPC) patients.@*Methods@#A total of 150 AJCC 7th stage Ⅱ-IVB NPCs receiving radical tomotherapy (TOMO) in Zhejiang Cancer Hospital from 2017 to 2019 were included in this prospective observational study. Oral cavity contour (OCC) and mucosal surface contour (MSC) were applied to delineate the oral mucosal structure. A-ROM grade was prospectively assessed and recorded weekly according to RTOG scoring criteria. The prediction value of two methods for A-ROM was statistically compared.@*Results@#The incidence rate of ≥3 grade A-ROM was 33.3%. In univariate analysis, V5, V10, V15, V45, V50, V55, V60, V65 and V70 of OCC and V5, V10, V50, V55, V60, V65, V70 and Dmean of MSC were significantly correlated with the risk of ≥3 grade A-ROM (all P<0.05). In binary logistic regression analysis, gender and smoking were significantly associated with the incidence of ≥3 grade A-ROM by using OCC (male vs. female: OR=0.141, 95%CI=0.037-0.538, P=0.004; smoking vs.non-smoking: OR=5.109, 95%CI=1.413-18.470, P=0.013). For MSC, gender, smoking, N stage and MSC- V55 were the independent predictors (male vs. female: OR=0.129, 95%CI=0.032-0.519, P=0.004; smoking vs.non-smoking: OR=4.448, 95%CI=1.224-16.164, P=0.023; N stage: OR=2.291, 95%CI=1.268-4.137, P=0.006; MSC-V55: OR=1.432, 95%CI=1.008-2.033, P=0.045). The cutoff value of MSC-V55 was 7.70%, the area under ROC curve was 0.754, the sensitivity and specificity were 0.680 and 0.740, retrospectively (all P<0.001).@*Conclusions@#Compared with OCC, MSC yields a higher prediction accuracy for the severity of A-ROM in nasopharyngeal carcinoma patients receiving TOMO treatment.
ABSTRACT
Objective To evaluate the value of two oral mucosal contouring methods for predicting acute radiation-induced oral mucositis (A-ROM) in nasopharyngeal carcinoma (NPC) patients.Methods A total of 150 AJCC 7th stage Ⅱ-ⅣB NPCs receiving radical tomotherapy (TOMO) in Zhejiang Cancer Hospital from 2017 to 2019 were included in this prospective observational study.Oral cavity contour (OCC) and mucosal surface contour (MSC) were applied to delineate the oral mucosal structure.A-ROM grade was prospectively assessed and recorded weekly according to RTOG scoring criteria.The prediction value of two methods for A-ROM was statistically compared.Results The incidence rate of ≥ 3 grade A-ROM was 33.3％.In univariate analysis,V5,V10,V15,V45,V50,V55,V60,V65 and V70 of OCC and V5,V10,V50,V55,V60,V65,V70 and Dmean of MSC were significantly correlated with the risk of ≥3 grade A-ROM (all P＜0.05).In binary logistic regression analysis,gender and smoking were significantly associated with the incidence of ≥3 grade A-ROM by using OCC (male vs.female:OR=0.141,95％CI=0.037-0.538,P=0.004;smoking vs.non-smoking:OR=5.109,95％CI=1.413-18.470,P=0.013).For MSC,gender,smoking,N stage and MSC-V55 were the independent predictors (male vs.female:OR=0.129,95％CI=0.032-0.519,P=0.004;smoking vs.non-smoking:OR=4.448,95％CI=1.224-16.164,P=0.023;N stage:OR=2.291,95％CI=1.268-4.137,P=0.006;MSC-V55:OR=1.432,95％CI=1.008-2.033,P=0.045).The cutoff value of MSC-V55 was 7.70％,the area under ROC curve was 0.754,the sensitivity and specificity were 0.680 and 0.740,retrospectively (all P＜0.001).Conclusions Compared with OCC,MSC yields a higher prediction accuracy for the severity of A-ROM in nasopharyngeal carcinoma patients receiving TOMO treatment.
ABSTRACT
Objective To evaluate the impact of nutritional therapy during radiotherapy for patients with locoregionally advanced (Ⅲ-ⅣB) nasopharyngeal carcinoma (NPC) and identify factors that might influence nutritional status of the patients.Methods We retrospectively reviewed 117 patients with locoregionally advanced NPC (Ⅲ-ⅣB) treated with radical radiotherapy between December 2015 and March 2016 at Zhejiang Cancer Hospital.The patients were grouped into those who received nutritional therapy and those who did not during radiotherapy.Chi-square test was used for both inter-and intra-group comparison of nutritional status before (T0),during (T1) and after radiotherapy (T3).The patients were then grouped into those who experienced substantial weight loss (＞5％) and those who did not (≤5％),and Logistic regression was used to analyze factors that were potentially correlated with weight loss.Results Nutritional indicators were all on the decrease (T2 vs.T0,T1 vs.T0,P＜0.001),including weight,body mass index (BMI),albumin,pre-albumin (PA),and prognostic nutritional index (PNI).There was no significant difference between the group who received nutritional therapy and the one who did not in weight,albumin,PA,and PNI at a given time point (P＞ 0.05),but patients in nutritional therapy group completed radiotherapy in fewer days than those in the control group (45.8 d vs.46.0 d,P=0.023).Logistic regression revealed that patients with radiation-induced oral mucositis of grade≥3 (Odds ratio=3.232,P=0.021,95％ CI=1.198-8.820) and drop of pre-albumin by ＞15％ (Odds ratio=2.442,P=0.041,95％ CI=1.036-5.757) had greater risk of developing nutritional impairment.Conclusions Radiation-induced oral mucositis of grade≥3 might lead to deteriorating nutritional impairment in patients with locoregionally advanced NPC during radiotherapy,and drop of pre-albumin by ＞ 15％ was correlated with weight loss.Current nutritional support fell short of improving nutritional impairment during radiotherapy.
ABSTRACT
Objective To observe the physical development indexes of students from a teenager aviation school and to find out about the trainees′characteristics of physical development in order to advise on medical selection of teenager flying cadets and improve the present training programs .Methods Four hundred and thirty six students Grade 2015 were selected as subjects .The data of their physical examinations between school selection examination and annual examination were compared via matched-pair design.Physical growth and development of students in the aviation school were analyzed . Results The height, relative body mass and body mass index (IBM) of the students changed significantly (P<0.05) after one-year training in the youth aviation school .The proportion of students whose body mass accounted for 85% to 120%of standard weight was increased from 84.40%to 93.12%.94.74%of the increase came from students who used to be underweight .The qualified rate of students who reached the 70%-79% of the standard relative body mass in school selection examination was 57.14%.The reached qualified rate of students who reached the 80%-84% of the standard relative body mass in school selection examination was as high as 95.65%.The average height growth of the students was about 2.0 cm in the previous year .Conclusion The relative body mass of students who reached the 70%-85% of the standard relative body mass in school selection examination improved obviously ,suggesting that we should revise the weight standard to less than 30% of the standard weight , which conforms to the objective law of growth and development of adolescents .The rate of development of adolescent height requires further follow-up observation .All the students of a teenager aviation school should pay attention to a reasonable diet , take more physical exercise and monitor body mass .
ABSTRACT
Objective To discuss the reasons for the difference in the results of medical checkups for cardidates enlisted in teenager aviation classes, in order to offer tips for the establishment of regional training programs and improve the qualification rate and acceptability.Methods A total of 2894 junior high school graduates as candidates for selection to teenager aviation classes in 2015 were given a double-blind medical examination.Cross-sectional survey methodology was used to compare the differences in the results of physical examinations, for candidates from seven areas.Results The qualification rate of physical checkups in the above regions were significantly different.The regional differences in the rejection rate related to ophthalmology, surgery, neurology and ultrasound were significant(P 0.05).The vision, height and relative body mass in different regions were significantly different (P0.05).Conclusion The physical differences are the results of various factors.In order to improve the passing rate of candidats, the aviation training plan for teenager aviation classes should consider the geography, climate, socio-economic environment and the physical health of local students.We should implement training programs in line with local conditions reather than use a unified national standard.
ABSTRACT
<p><b>BACKGROUND</b>Intravascular microbubble-enhanced acoustic cavitation is capable of disrupting the vascular walls of capillaries and small vessels. This study was designed to investigate the impact of microbubble-enhanced, pulsed and focused ultrasound (MEUS) on the blood perfusion of subcutaneous VX2 tumors in rabbits.</p><p><b>METHODS</b>Subcutaneous VX2 cancers in twenty New Zealand rabbits were treated by combining high-pressure amplitude, pulsed and focused therapeutic ultrasound (TUS) and intravenous microbubble injections. The TUS transducer was operated with a peak negative pressure of 4.6 MPa and a duty cycle of 0.41%. Controls were subcutaneous VX2 cancers treated with TUS or microbubbles only. Contrast-enhanced ultrasound (CEUS) and intravenous Evans Blue (EB) perfusion were performed to assess the tumor circulation. The tumor microvascular disruption was assessed by histological examination.</p><p><b>RESULTS</b>CEUS showed that the tumor circulation almost vanished after MEUS treatment. The average peak grayscale value (GSV) of tumor CEUS dropped significantly from 84.1±22.4 to 15.8±10.8 in the MEUS-treated tumors but no significant GSV changes were found in tumors in the two control groups. The mean tumor EB content of the MEUS-treated tumors was significantly lower than that of the controls. Histological examination found scattered tumor microvascular disruption with intercellular edema after MEUS treatment.</p><p><b>CONCLUSION</b>The tumor circulation of VX2 cancers can be arrested or significantly reduced by MEUS due to microvascular disruption.</p>
Subject(s)
Animals , Rabbits , Contrast Media , High-Intensity Focused Ultrasound Ablation , Liver Neoplasms , Therapeutics , Microbubbles , Ultrasonic TherapyABSTRACT
Objective To compare two effective preparation methods for paclitaxel-loaded lipid microbubbles, and to evaluate the physiochemical properties as for acoustic activated drug delivery. Methods Paclitaxel-loaded lipid microbubbles were prepared with two methods: one was mixed with phospholipids directly (Ⅰ); the other was added in triacetin, then mixed with phospholipids (Ⅱ). Concent ration, size, pH, drug entrapment efficiency, drug-loading amounts of these two kinds of paclitaxel-loaded lipid microbubbles were studied, while drug release with ultrasound and tumor imaging enhanced on rabbit breast tumor were observed. Results There was no significant difference in tumor imaging between two kinds of microbubbles which could be ruptured by low energy ultrasound. Compared with Ⅰ, the mean diameter of Ⅱ decreased significantly ([ 1.07±0.38] μm vs [2.79± 0.41] μm, P<0.01), the surface potencial was higher ([19.10±0.32] mV vs [-5.90±0.21] mV, P<0.01), whereas entrapment efficiency and drug-loading amounts increased markedly ([ 95.00±1.22]% vs [36.10±4.74]%, P<0.01; [5.60±0.11]% vs [0.50±0.04]%, P<0.01). Conclusion The Ⅱ paclitaxel-loaded lipid microbubbles added triacetin have an important clinical value.