Relationship between nutrition impact symptoms and fat-free mass in patients with head and neck cancer during radiotherapy / 中华临床营养杂志

Objective:To observe the changes of nutrition impact symptoms (NIS) and fat-free mass and analyze the relationship between them in patients with head and neck cancer (HNC) during radiotherapy.Methods:A convenient sampling method was adopted to select HNC patients who received radiotherapy in the outpatient clinic of department of radiotherapy for head and neck cancer in a cancer hospital in Beijing from March 2017 to January 2020. The nutrition impact symptoms (NIS) were assessed by a nutrition impact symptoms checklist and the fat free mass was assessed by bioelectrical impedance analysis at three time points: before radiotherapy (T1), during radiotherapy (T2) and at the end of radiotherapy (T3). The Generalized Estimating Equations (GEE) was used to analyze the relationship between them.Results:A total of 542 HNC patients were included in the analysis. During radiotherapy, the patients' NIS number and score presented an increasing trend, reaching the highest level and peaked at the end of radiotherapy. The change of fat-free mass showed a decreasing trend and reached the minimum at the end of radiotherapy. Patients with higher NIS scores had more percentage loss of fat-free mass.Conclusions:During radiotherapy, patients with HNC showed an increase in NIS score and lost fat-free mass. Patients with higher NIS score lost more percentage of fat-free mass, which suggested that clinical medical staff should pay attention to NIS management and take comprehensive intervention measures in time to reduce the loss of fat-free mass.

A Large-Scale Clinical Validation Study Using nCapp Cloud Plus Terminal by Frontline Doctors for the Rapid Diagnosis of COVID-19 and COVID-19 pneumonia in China

BackgroundThe outbreak of coronavirus disease 2019 (COVID-19) has become a global pandemic acute infectious disease, especially with the features of possible asymptomatic carriers and high contagiousness. It causes acute respiratory distress syndrome and results in a high mortality rate if pneumonia is involved. Currently, it is difficult to quickly identify asymptomatic cases or COVID-19 patients with pneumonia due to limited access to reverse transcription-polymerase chain reaction (RT-PCR) nucleic acid tests and CT scans, which facilitates the spread of the disease at the community level, and contributes to the overwhelming of medical resources in intensive care units. GoalThis study aimed to develop a scientific and rigorous clinical diagnostic tool for the rapid prediction of COVID-19 cases based on a COVID-19 clinical case database in China, and to assist global frontline doctors to efficiently and precisely diagnose asymptomatic COVID-19 patients and cases who had a false-negative RT-PCR test result. MethodsWith online consent, and the approval of the ethics committee of Zhongshan Hospital Fudan Unversity (approval number B2020-032R) to ensure that patient privacy is protected, clinical information has been uploaded in real-time through the New Coronavirus Intelligent Auto-diagnostic Assistant Application of cloud plus terminal (nCapp) by doctors from different cities (Wuhan, Shanghai, Harbin, Dalian, Wuxi, Qingdao, Rizhao, and Bengbu) during the COVID-19 outbreak in China. By quality control and data anonymization on the platform, a total of 3,249 cases from COVID-19 high-risk groups were collected. These patients had SARS-CoV-2 RT-PCR test results and chest CT scans, both of which were used as the gold standard for the diagnosis of COVID-19 and COVID-19 pneumonia. In particular, the dataset included 137 indeterminate cases who initially did not have RT-PCR tests and subsequently had positive RT-PCR results, 62 suspected cases who initially had false-negative RT-PCR test results and subsequently had positive RT-PCR results, and 122 asymptomatic cases who had positive RT-PCR test results, amongst whom 31 cases were diagnosed. We also integrated the function of a survey in nCapp to collect user feedback from frontline doctors. FindingsWe applied the statistical method of a multi-factor regression model to the training dataset (1,624 cases) and developed a prediction model for COVID-19 with 9 clinical indicators that are fast and accessible: Residing or visiting history in epidemic regions, Exposure history to COVID-19 patient, Dry cough, Fatigue, Breathlessness, No body temperature decrease after antibiotic treatment, Fingertip blood oxygen saturation [≤]93%, Lymphopenia, and C-reactive protein (CRP) increased. The area under the receiver operating characteristic (ROC) curve (AUC) for the model was 0.88 (95% CI: 0.86, 0.89) in the training dataset and 0.84 (95% CI: 0.82, 0.86) in the validation dataset (1,625 cases). To ensure the sensitivity of the model, we used a cutoff value of 0.09. The sensitivity and specificity of the model were 98.0% (95% CI: 96.9%, 99.1%) and 17.3% (95% CI: 15.0%, 19.6%), respectively, in the training dataset, and 96.5% (95% CI: 95.1%, 98.0%) and 18.8% (95% CI: 16.4%, 21.2%), respectively, in the validation dataset. In the subset of the 137 indeterminate cases who initially did not have RT-PCR tests and subsequently had positive RT-PCR results, the model predicted 132 cases, accounting for 96.4% (95% CI: 91.7%, 98.8%) of the cases. In the subset of the 62 suspected cases who initially had false-negative RT-PCR test results and subsequently had positive RT-PCR results, the model predicted 59 cases, accounting for 95.2% (95% CI: 86.5%, 99.0%) of the cases. Considering the specificity of the model, we used a cutoff value of 0.32. The sensitivity and specificity of the model were 83.5% (95% CI: 80.5%, 86.4%) and 83.2% (95% CI: 80.9%, 85.5%), respectively, in the training dataset, and 79.6% (95% CI: 76.4%, 82.8%) and 81.3% (95% CI: 78.9%, 83.7%), respectively, in the validation dataset, which is very close to the published AI model. The results of the online survey Questionnaire Star showed that 90.9% of nCapp users in WeChat mini programs were satisfied or very satisfied with the tool. The WeChat mini program received a significantly higher satisfaction rate than other platforms, especially for availability and sharing convenience of the App and fast speed of log-in and data entry. DiscussionWith the assistance of nCapp, a mobile-based diagnostic tool developed from a large database that we collected from COVID-19 high-risk groups in China, frontline doctors can rapidly identify asymptomatic patients and avoid misdiagnoses of cases with false-negative RT-PCR results. These patients require timely isolation or close medical supervision. By applying the model, medical resources can be allocated more reasonably, and missed diagnoses can be reduced. In addition, further education and interaction among medical professionals can improve the diagnostic efficiency for COVID-19, thus avoiding the transmission of the disease from asymptomatic patients at the community level.

Pulmonary radiological change of COVID-19 patients with 99mTc-MDP treatment

BackgroundAs increasing cases of COVID-19 around world, urgent need for effective COVID-19-specific therapeutic drugs is necessary; therefore, we conducted a pilot randomized-controlled study to evaluate the efficacy of 99mTc-MDP for COVID-19 therapeutic treatment. MethodsA total of 21 mild patients with COVID-19 were enrolled in this pilot RCT from February 2020 through March 2020, and then were assigned, in a 1:1 ratio, into control (11 patients) and 99mTc-MDP group (10 patients). Patients in the control group received routine treatment and patients assigned to the 99mTc-MDP group received a combination of routine treatment and an administration of 99mTc-MDP injection of 5ml/day. Both of the patients in the control and 99mTc-MDP groups were treated for 7 days with the primary end point of CT-based radiological pulmonary changes during 7-day follow-up. FindingsFrom baseline to the day 7, 8 (80%) of 10 mild patients in the 99mTc-MDP group had a significant radiological improvement in lung and a decline in inflammatory infiltration, whereas only 1 (9.1%) of 11 patients in the control group had a radiological improvement in lung. None of the patients in the 99mTc-MDP group had disease progression from mild to severe, as well as an inflammatory cytokine storm, and 2 mild patients (18.2%) in the control group developed severe. During days 7 through 14, the number of patients with radiological improvement in the 99mTc-MDP group remained consistent, and only 1 additional case (22%) in the control group were reported. ConclusionIn this randomized pilot study, 99mTc-MDP had an effective inhibitory effect on the inflammatory disease progression for the therapy of COVID-19, and it can accelerate the absorption of pulmonary inflammation in a short period of time during the process of treatment.

Chinese Society of Allergy and Chinese Society of Otorhinolaryngology-Head and Neck Surgery Guideline for Chronic Rhinosinusitis

The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines—with a focus on China—will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.

Radiation induced mucositis and its relationship with nutritional status in head and neck cancer patients treated with radiotherapy / 中华临床营养杂志

Objective To describe the characteristics of radiation induced mucositis in patients withhead and neck cancer ( HNC) during radiotherapy, and analyze the effect of radiation induced mucositis on diet patterns and weight change and the influencing factors for radiation induced mucositis. Methods Patients with HNC treated with radiotherapy in one cancer hospital were recruited. Data were collected before, during and at the end of the radiotherapy, which included radiation induced oral and pharyngeal mucositis, pain during eat-ing, diet patterns and weight. Results Two hundred and two patients were completely investigated and 43.5％and 34. 2％ of the patients suffered from moderate to severe (≥grade 2) oral mucositis and pharyngeal mucosi-tis, respectively during the radiotherapy. At the end of radiotherapy, 53. 5％ and 51. 5％ of the patients suffered from moderate to severe oral mucositis and pharyngeal mucositis (≥grade 2 ) , respectively. Oral and pharyngeal mucositis were significantly correlated with pain during eating, diet patterns and weight ( P<0. 05) . Tumor site was the main reason that affected the severity of mucositis ( Wald χ2 =26. 033, 14. 216;P<0.001). Conclusion Radiation induced mucositis was gradually aggravated with radiotherapy progress, which is closely related to pain during eating, change of diet patterns and weight loss. The severity of mucositis is re-lated to the tumor site. Measures should be taken to strengthen the management of adverse reactions and nutri-tional status of patients.

Dysphagia and its relationship with weight change in head and neck cancer patients treated with radiotherapy / 中华临床营养杂志

Objective To describe the characteristics of dysphagia in patients with head and neck cancer during radiotherapy,and analyze the cause of dysphagia and the relationship between dysphagia and weight change.Methods Patients with head and neck cancer treated with radiotherapy in Beijing Cancer Hospital from November 2017 to June 2018 were recruited.The M.D.Anderson Dysphagia Inventory (MDADI) was used to assess the dysphagia of patients before (T1),during (T2) and at the end (T3) of the radiotherapy.Meanwhile,the weight,dietary intake and radiation adverse effects were investigated.Generalized estimating equations were used to analyze the impact factors of dysphagia and the relationship among dysphagia,dietary intake and weight change.Results Ninety-six patients were completely investigated and the incidence of dysphagia were 6.3％ (6/ 96),80.2％ (77/96) and 85.4％ (82/96) in T1,T2 and T3.With the progress of radiotherapy,the total score and the scores of 4 dimensions of MDADI dropped and the dietary intake declined.The average weight loss was (5.09±3.31) kg,and 76.1％ of the patients had weight loss over 5％ at the end of radiotherapy.The occurrence of dysphagia was associated with the radiotherapy-related oral and laryngeal mucositis and the weight loss was closely associated with the site of radiation,dysphagia,and dietary intake decline.Conclusions The dysphagia of patients with head and neck cancer is affected by radiation adverse effects,and is most severe at the end of radiotherapy.Dysphagia might result in dietary intake decline and weight loss.Clinicians should pay close attention to the swallowing function of the patients and take measures earlier accordingly.

Taste alteration of head and neck cancer patients treated with radiotherapy: A longitudinal study / 中华临床营养杂志

Objective To investigate the taste alteration caused by radiotherapy and its relationship with nutritional status in head and neck cancer patients during and after radiotherapy.Methods From March to November 2017,172 patients with head and neck cancer receiving radiotherapy were recruited from Beijing Cancer Hospital including 86 patients completing all follow up visits.Chemotherapy-induced Taste Alteration scale was used to evaluate radiotherapy-induced taste alteration and the Patient-generated subjective global assessment (PGSGA) was used for nutrition evaluation at baseline,mid-treatment,post-treatment and 1-2 months after radiotherapy (follow-up).Generalized estimating equations was applied to analyze the influencing factors of taste alteration and its relationship with nutritional status.Results The incidence of taste alteration were 9.3％,84.9％,94.2％ and 77.9％ respectively at baseline,mid-treatment,post-treatment and 1-2 months after radiotherapy (follow-up).Taste alteration score increased with the increase of radiation dose,reached the highest at the posttreatment and decreased at follow-up visit which was still higher than the score at baseline.PG-SGA score increased with the increase of radiation dose.The incidence of severe malnutrition after radiotherapy was 95.3％,decreased to 45.3％ at follow up visit.Nutritional status was closely related to taste alteration.Total radiation dose and concurrent chemotherapy were the influencing factors of taste alteration.Conclusions The taste of patients with head and neck cancer is affected by radiotherapy.As radiotherapy continues,the taste alteration aggravates and PG-SGA score increases gradually,thus malnutrition becomes a prominent problem.Such effect will persist for a period of time after radiotherapy,which should be paid attention and interventions should be conducted to prevent or reduce this effect,in order that the lasting of malnutrition induced by taste alteration can be avoided.

Detection of fibrinogen, ICAM-1, VCAM-1in blood serum of elderly patients with sudden sensorineural hearing loss and clinical signiifcance / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo investigate the change of fibrinogen, soluable intercellular adhesion molecules-1 (sICAM-1), soluable vascular cell adhesion molecule-1 (sVCAM-1) in the blood of elderly patients with sudden sensorineural hearing loss (SSHL) and the difference between different type of SSHL.METHODS40 elderly patients with SSHL were subdivided into different types according to the newest guideline of diagnosis and treatment of Chinese medical association.They were subdivided into two groups with or without comorbidities.The control group were made of 40 healthy elderly people.The expression of fibrinogen, sICAM-1 and sVCAM-1 in the blood serum were detected and statistically analysed.RESULTSThe expression of fibrinogen, sICAM-1 and sVCAM-1 in SSHL patients were higher than that of the control group with statistical significance.There is no significant difference between different types of SSHL,though significant difference were found between groups with and without comorbidities. CONCLUSIONThere is increased expression of fibrinogen, sICAM-1 and sVCAM-1 in elderly SSHL patients;microcirculation dysfunction may play an dominant role in the pathogenesis of elderly patients with SSHL.

Analysis of related detections before blood transfusion in tumor patients / 国际检验医学杂志

Objective To investigate the detection situation and distribution of blood typing positive and negative disagree and irregular antibody positive in blood transfusion related tests in tumor patients ,and to make comparative analysis with the data of non‐tumor patients .Methods The results data in 16 760 patients with blood preparation in our hospital from November 2011 to June 2015 were selected and divided into the tumor patients group and the non‐tumor patients group .Among them ,the results of blood typing positive and negative disagree and positive in the irregular antibody screening test were statistically analyzed .Results 27 cases were ABO blood type positive typing inconsistent with reverse typing ,the occurrence rate of the tumor patients group was 0 .65% ,which of the non‐tumor patients group was 0 .08% ;the irregular antibody positive was in 49 cases ,in which 18 cases were in the tumor patients group with the occurrence rate of 0 .74% ,31 cases were in the non‐tumor patients group witht e occurrence rate of 0 .22% ,showing that the occurrence proportion of blood typing positive and reverse inconsistency and irregular antigen posi‐tive was higher than that of the non‐tumor patients group ,the difference was statistically significant (P<0 .05) ,31 cases in the non‐cancer group ,the positive rate is 0 .22% .18 cases in cancer‐group with 0 .74% incidence rate .It shows that the proportion of posi‐tive in cancer patients was higher than non‐cancer patients (P<0 .05) .The main influencing factors affecting blood typing problems in the tumor patients group and non‐tumor patients group were the antibody weakening ,followed by autoantibody ,etc .the reasons for the irregular antibody screening positive in the two groups were mainly the specific antibodies .Conclusion The disease charac‐teristics of tumor patients are easier to cause ABO blood type positive and reverse inconsistency and irregular antibody screening positive .In the work ,more attention should be paid to the detection results for avoiding the missed detection ,increasing the identifi‐cation ability and ensuring the blood transfusion safety .determination is more often in cancer patients about Tests about blood transfusion ;This should be relate to character of phymatosis .Much concern should be given to related test of cancer patients′blood transfusion ,avoiding omissions ,and improve the safety of blood infusion .

Study of clinical blood management mode for regional medical center / 国际检验医学杂志

Objective To explore the management mode of regional clinical blood ,as well as the role of Regional Medical Center in the blood management ,and have a comprehensive understanding of Daxing district clinical blood using present situation .Methods Organized Daxing district clinical blood using quality control center experts to do a research of 18 medical institutions in the blood management status of clinical blood demand within the jurisdiction ,and analyzed the statistics related to clinical use of blood in vari‐ous medical institutions from January to December in 2014 ,according to Beijing Wei Yi [2008]189 words in medical institutions of Beijing City ,the department of transfusion(blood bank) in the relevant provisions of the basic standard.Results Through the sur‐vey ,only regional medical center established the department of transfusion in 18 medical institutions ,other medical institutions have set up blood bank .Practitioners of department of transfusion (blood bank) in the number full‐time staff ,with post qualification num‐ber and degree of structure ,difference between regional medical center and other kind hospitals was significant (P0 .05) .Three grade hospitals in biological safety and continuous im‐provement of quality ,could be carried out in accordance with the PDCA cycle ,and have obvious advantages compared with the other one or two grade hospitals .Conclusion Fifteen medical institutions do not have the clinical blood transfusion compatibility testing conditions .To ensure the safety of blood for clinical use ,blood need to be tested by the department of transfusion regional medical center .

Program design and application of CHEMCLIN ? 600 worksheet generation software / 国际检验医学杂志

Objective To design a worksheet generation software for satisfy the two CHEMCLIN ? 600 instruments (CC 600) and laboratory information system(LIS) data transmission needs in Daxing Hospital of Capital Medical University ,ensure consis‐tency and uniqueness of the test sample number .Methods Microsoft Visual Studio 2010 and DotNetBar for Windows Forms were used to develop a work table generation software .Results Work table generation software had good interface ,and the CC 600 sys‐tem interaction had the advantage of simple operation ,generation of working table was operating normally ,and data transmission with laboratory information system was correct .Conclusion The worksheet generation software solves CC 600 linking problem be‐tween different test batches ,gives full play to the detection performance of the two instruments ,clinical application effect is good .

The role of GRP78 on the resistance to cisplatin in SPCA-1 cell line / 中国肺癌杂志

<p><b>BACKGROUND AND OBJECTIVE</b>The expression levels of glucose-regulated protein 78 (GRP78) were elevated and correlated with resistance to chemotherapy drug VP-16 in lung cancer cells. However, little is known about the relationship between its expression and resistance to cisplatin in lung cancer cells. The aim of this study was to investigate the expression of GRP78 under the induction of A23187 and its significance in the resistance to anti-tumor drugs cisplatin in a human lung cancer SPCA-1 cell line.</p><p><b>METHODS</b>RT-PCR and Western blot were used to analyze the expression of GRP78 at mRNA and protein levels in SPCA-1 cell line induced byA23187 at different concentrations (0, 1, 2, 4, 6 microM). MTT was used to determine the effect of cisplation on cell survival.</p><p><b>RESULTS</b>The expressions of GRP78 at both mRNA and protein levels were increased obviously in SPCA-1 cell line induced by A23187, with a manner of dose-dependent of A23187 to a great degree; MTT assay showed that the cell survival rate of the A23187-induced group decreased significantly compare to the control group, also with a concentration-dependent manner of A23187.</p><p><b>CONCLUSION</b>The expression of GRP78 at both mRNA and protein levels were increased obviously in SPCA-1 cell line induced by A23187. The enhancement of GRP78 showed a negative correlation with the cell survival rate treated by cisplatin. All these indicated that overexpression of GRP78 can enhance the sensitivity to cisplatin and there is correlation between the expression of GRP78 and resistance to cisplatin of human lung cancer SPCA-1 cell line.</p>

Application of microfluidic gradient chip in the analysis of lung cancer chemotherapy resistance.

The major challenge of chemotherapy is the disease resistance for many lung cancer patients. Integrated microfluidic systems offer many desirable characteristics and can be used in cellular biological analysis. This work aimed to study the correlation between the expression of Glucose Regulated Protein-78 (GRP78) and the resistance to anticancer drug VP-16 in human lung squamous carcinoma cell line SK-MES-1 using an integrated microfluidic gradient chip device. We used A23187, a GRP78 inducer, with a gradient concentration in the upstream network of the device to induce the expression of GRP78 in the cells cultured in the downstream before the addition of VP-16. The expression of GRP78 was detected by immunofluorescence, the apoptosis for the cells treated by VP-16 was assessed morphologically by 4',6-diamidino-2-phenylindole (DAPI) staining. The results indicated that the expressions of GRP78 increased greatly for the cells under the induction of A23187 with a dose-depended manner, while the percentage of apoptotic cells decreased significantly after being treated by VP-16. Our results from this study confirmed the role of GRP78 played in the chemotherapy resistance to VP-16 in SK-MES-1 cell line, suggesting that the integrated microfluidic systems may be an unique approach for characterizing the cellular responses.