Yinlai Decoction Protects Microstructure of Colon and Regulates Serum Level of D-Lactic Acid in Pneumonia Mice Fed with High-Calorie and High-Protein Diet / 中国结合医学杂志

OBJECTIVE@#To investigate the effect of Yinlai Decoction (YD) on the microstructure of colon, and activity of D-lactic acid (DLA) and diamine oxidase (DAO) in serum of pneumonia mice model fed with high-calorie and high-protein diet (HCD).@*METHODS@#Sixty male Kunming mice were randomly divided into 6 groups by the random number table method: normal control, pneumonia, HCD, HCD with pneumonia (HCD-P), YD (229.2 mg/mL), and dexamethasone (15.63 mg/mL) groups, with 10 in each group. HCD mice were fed with 52% milk solution by gavage. Pneumonia mice was modeled with lipopolysaccharide inhalation and was fed by gavage with either the corresponding therapeutic drugs or saline water, twice daily, for 3 days. After hematoxylin-eosin staining, the changes in the colon structure were observed under light microscopy and transmission electron microscope, respectively. Enzyme-linked immunosorbent assay was used to detect the protein levels of DLA and DAO in the serum of mice.@*RESULTS@#The colonic mucosal structure and ultrastructure of mice in the normal control group were clear and intact. The colonic mucosal goblet cells in the pneumonia group tended to increase, and the size of the microvilli varied. In the HCD-P group, the mucosal goblet cells showed a marked increase in size with increased secretory activity. Loose mucosal epithelial connections were also observed, as shown by widened intercellular gaps with short sparse microvilli. These pathological changes of intestinal mucosa were significantly reduced in mouse models with YD treatment, while there was no significant improvement after dexamethasone treatment. The serum DLA level was significantly higher in the pneumonia, HCD, and HCD-P groups as compared with the normal control group (P<0.05). Serum DLA was significantly lower in the YD group than HCD-P group (P<0.05). Moreover, serum DLA level significantly increased in the dexamethasone group as compared with the YD group (P<0.01). There was no statistical significance in the serum level of DAO among groups (P>0.05).@*CONCLUSIONS@#YD can protect function of intestinal mucosa by improving the tissue morphology of intestinal mucosa and maintaining integrity of cell connections and microvilli structure, thereby reducing permeability of intestinal mucosa to regulate the serum levels of DLA in mice.

Application of Bodyfix fixation device in stereotactic body radiotherapy for elderly patients with lung cancer / 肿瘤研究与临床

Objective:To explore the clinical application value of Bodyfix fixation device in stereotactic body radiotherapy (SBRT) for elderly patients with lung cancer.Methods:The clinical data of 63 elderly patients with lung cancer who received SBRT in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January to October 2021 were retrospectively analyzed. According to different fixation methods, the patients were divided into Bodyfix combined with vacuum bag fixation device group (Bodyfix group, 20 cases) and 4D respiratory gating technology combined with vacuum bag fixation device group (vacuum bag group, 43 cases). Cone beam CT (CBCT) was used for position verification before each treatment, linear and rotational errors in the horizontal (X), head-to-foot (Y), front-to-back (Z) directions were recorded.Results:The linear errors of Bodyfix group in the X, Y and Z directions were 1.7 mm (1.3 mm, 3.0 mm), 4.6 mm (4.3 mm, 5.3 mm) and 1.3 mm (0.8 mm, 2.8 mm), and the rotational errors were (0.46±0.04)°, (-0.48±0.05)° and 0.64°(0.38°, 1.07°); the linear errors of vacuum bag group in the X, Y and Z directions were 2.1 mm (1.6 mm, 3.3 mm), 2.8 mm (1.8 mm, 3.7 mm) and 3.0 mm (2.3 mm, 3.8 mm), and the rotational errors were (0.69±0.04)°, (-0.70±0.04)° and 0.64° (0.42°, 0.86°). The differences in linear errors in the Y and Z directions and rotational errors in the X and Y directions between the two groups were statistically significant ( P values were <0.001, <0.001, 0.003 and 0.007). Conclusions:Compared with the 4D respiratory gating technology, the Bodyfix fixation device has smaller rotational errors in the X and Y directions and linear errors in the Z direction. It can be used as an effective method of postural fixation for SBRT in elderly patients with lung cancer.

Long-term outcomes and independent predictors of mortality in patients presenting to emergency departments with acute heart failure in Beijing: a multicenter cohort study with a 5-year follow-up / 中华医学杂志(英文版)

BACKGROUND@#Acute heart failure (AHF) is the most common disease in emergency departments (EDs). However, clinical data exploring the outcomes of patients presenting AHF in EDs are limited, especially the long-term outcomes. The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors.@*METHODS@#This prospective, multicenter, cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1, 2011 and September 23, 2012. Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors.@*RESULTS@#The 5-year mortality and cardiovascular death rates were 55.4% and 49.6%, respectively. The median overall survival was 34 months. Independent predictors of 5-year mortality were patient age (hazard ratio [HR]: 1.027, 95 confidence interval [CI]: 1.023-1.030), body mass index (BMI) (HR: 0.971, 95% CI: 0.958-0.983), fatigue (HR: 1.127, 95% CI: 1.009-1.258), ascites (HR: 1.190, 95% CI: 1.057-1.340), hepatic jugular reflux (HR: 1.339, 95% CI: 1.140-1.572), New York Heart Association (NYHA) class III to IV (HR: 1.511, 95% CI: 1.291-1.769), heart rate (HR: 1.003, 95% CI: 1.001-1.005), diastolic blood pressure (DBP) (HR: 0.996, 95% CI: 0.993-0.999), blood urea nitrogen (BUN) (HR: 1.014, 95% CI: 1.008-1.020), B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in the third (HR: 1.426, 95% CI: 1.220-1.668) or fourth quartile (HR: 1.437, 95% CI: 1.223-1.690), serum sodium (HR: 0.980, 95% CI: 0.972-0.988), serum albumin (HR: 0.981, 95% CI: 0.971-0.992), ischemic heart diseases (HR: 1.195, 95% CI: 1.073-1.331), primary cardiomyopathy (HR: 1.382, 95% CI: 1.183-1.614), diabetes (HR: 1.118, 95% CI: 1.010-1.237), stroke (HR: 1.252, 95% CI: 1.121-1.397), and the use of diuretics (HR: 0.714, 95% CI: 0.626-0.814), β-blockers (HR: 0.673, 95% CI: 0.588-0.769), angiotensin-converting enzyme inhibitors (ACEIs) (HR: 0.714, 95% CI: 0.604-0.845), angiotensin-II receptor blockers (ARBs) (HR: 0.790, 95% CI: 0.646-0.965), spironolactone (HR: 0.814, 95% CI: 0.663-0.999), calcium antagonists (HR: 0.624, 95% CI: 0.531-0.733), nitrates (HR: 0.715, 95% CI: 0.631-0.811), and digoxin (HR: 0.579, 95% CI: 0.465-0.721).@*CONCLUSIONS@#The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF. Age, BMI, fatigue, ascites, hepatic jugular reflux, NYHA class III to IV, heart rate, DBP, BUN, BNP/NT-proBNP level in the third or fourth quartile, serum sodium, serum albumin, ischemic heart diseases, primary cardiomyopathy, diabetes, stroke, and the use of diuretics, β-blockers, ACEIs, ARBs, spironolactone, calcium antagonists, nitrates, and digoxin were independently associated with 5-year all-cause mortality.

Discussion and consideration on pharmacology and toxicology of Areca catechu and its rational application / 中草药

Areca catechu ranks the first of China's precious "four southern medicines", with a history of more than 1 800 years of medicinal use and extensive clinical application. The pharmacological effects of A. catechu mainly focus on insect repellent, anti-tumor, anti-aging, anti-atherosclerosis and the effects on digestive system and nervous system. In recent years, safety problems such as oral cancer caused by consumption of A. catechu have been frequently reported, and the main chemical components of both medicinal and edible A. catechu are arecoline, so the clinical safety of medicinal A. catechu has been questioned. Based on the chemical composition, this paper analyzes the pharmacological and toxicological characteristics of A. catechu, discusses the points for attention in clinical application, in order to provide a reference basis for the clinical safe and rational use of A. catechu.

Characteristics of death distribution of critical patients in a single emergency center in Beijing / 中国实用内科杂志

OBJECTIVE: To explore the characteristics of death distribution in emergency critical care patients and guide the distribution of emergency resources.METHODS: Clinical data of all patients who died in the emergency department of Peking University third hospital from 2013 to 2017 were collected.Age,gender composition and time of death were analyzed.Pareto diagram was used to analyze the composition of causes of death.RESULTS:(1)Elderly patients(≥60 years old)accounted for81.0% of the total number of deaths,and the age difference has statistically significant(P<0.05).(2)Pareto diagram analysis showed that respiratory diseases,sudden death,shock and nervous diseases were the main causes of death in critically ill patients.(3)Age was associated with respiratory diseases,cardiovascular diseases,shock,sudden death,nervous diseases and trauma(P<0.05).Gender was associated with respiratory diseases,sudden death and trauma(P<0.05).(4)50.8% the death cases occurred within 24 h after admission,the median time of sudden death patients is the shortest(1 h),followed by shock(24 h).The median time of death of malignant tumor was up to 5040 h.CONCLUSION: Elderly patients are the major death group in the emergency department.Respiratory,circulatory and neurological diseases are the common causes of death.And most patients die in the early stage of treatment.Therefore,it is necessary to reasonably allocate emergency medical resources according to the actual situation.

Causes and countermeasures of emergency department overcrowding / 中国中西医结合急救杂志

With the progresses of aggravation of social population aging degree and elevation of health awareness, the emergency medical resources are difficult to meet the increasing demand for emergency medical services of patients, leading to the increase of congestion in the Department of Emergency that has threatened the safety of the entire medical and health system. Among the patients, because the elderly patient diseases are characterized by coexistence of multiple diseases, the complexity of diagnosis and treatment, etc, they occupy a large number of emergency medical resources, resulting in the main important factor affecting the overcrowding in emergency department. Therefore, we have comprehensively analyzed the domestic and foreign researches related to the overcrowding in emergency departments, summarized the effect of elderly patients on the overcrowding and reviewed the corresponding mitigation measures, expecting to provide a reference for the study of emergency department overcrowding in China.

Study on Improvement Effects of Fuling Gancao Decoction on Functional Dyspepsia Model Rats / 中国药房

OBJECTIVE： To study improvement effects of Fuling gancao decoction on functional dyspepsia （FD） model rats. METHODS： Sixty SD rats were randomly divided into normal group， model group， Fuling gancao decoction high-dose group （20 g/kg）， Fuling gancao decoction low-dose group （10 g/kg）， drug combination group （Fuling gancao decoction 10 g/kg+domperidone 0.004 g/kg）， domperidone group （0.004 g/kg）， with 10 rats in each group. Except for normal group， other groups were givenicy dilute hydrochloric acid intragastrically to establish FD model.  After modeling， normal group and model group were given constant volume of distilled water at room temperature intragastrically， and other groups were given relevant drug solution （1 mL/100 g） intragastrically， once a day， for consecutive 7 d. The amount of gastric residue was measured to evaluate the gastric emptying function. Immunohistochemistry SP method was used to detect the protein expression of AQP3， Ghrelin and Substance P in gastric mucosa tissue. The protein expression of Claudin-1， Occludin and VIP were detected by Western blot assay. RESULTS： Compared with normal group， the amount of gastric residue was increased significantly in model group （P＜0.01）； positive expression of AQP3 and Ghrelin protein in gastric mucosa tissue was decreased significantly， while the positive expression of Substance P protein tended to increase； the protein expression levels of AQP3， Ghrelin， Claudin-1 and Occludin were decreased significantly， while those of Substance P and VIP were increased significantly （P＜0.05 or P＜0.01）. Compared with model group， the amount of gastric residue was decreased significantly in administration groups （P＜0.05 or P＜0.01）； the positive expression of AQP3 and Ghrelin protein tended to increase， while less positive expression of Substance P was found； the protein expression levels of AQP3 and Occludin in gastric mucosa tissue were increased significantly in administration groups， while those of VIP were decreased significantly  （P＜0.05 or P＜0.01）； the protein expression levels of Ghrelin and Claudin-1 in gastric mucosa tissue were increased significantly in Fuling gancao decoction high-dose group， Fuling gancao decoction low-dose group and drug combination group， while those of Substance P were decreased significantly （P＜0.05）. CONCLUSIONS： Fuling gancao decoction may improve the symptom of fluid retention in FD model rats by up-regulating the protein expression of AQP3， Ghrelin， Claudin-1 and Occludin and down-regulating the protein expression of Substance P and VIP in gastric mucosa tissue of rats.

Discussion on safety of Xanthii Fructus and consideration on its rational use / 中国中药杂志

Xanthii Fructus is a traditional Chinese medicine for the treatment of sinusitis and headache,rich in medicinal materials and is widely used for more than 1 800 years. Modern pharmacological studies have showed that Xanthii Fructus has anti-inflammatory,analgesic,anti-tumor,anti-bacterial,hypoglycemic,anti-allergic,immunomodulatory and other pharmacological effects,which can be commonly used in the treatment of diseases relating to immune abnormalities,such as rheumatoid arthritis,acute and chronic rhinitis,allergic rhinitis,and skin diseases,with a high medicinal value. Toxicological studies have shown that Xanthii Fructus poisoning can cause substantial damage to organs,such as the liver,kidney,and gastrointestinal tract,especially to liver. Because of the coexisting of its efficacy and toxicity,Xanthii Fructus often leads to a series of safety problems in the clinical application process. This study attempts to summarize its characteristics of adverse reactions,analyze the root cause of the toxicity of Xanthii Fructus from such aspects as processing,dose,course of treatment and eating by mistake,discuss the substance of its efficacy/toxicity from chemical compositions,and put forward exploratory thinking about how to promote its clinical rational application from the aspects such as strict processing,reasonable compatibility,medication information,contraindication,strict control of the dose,and course of treatment,so as to promote the safe and reasonable application of Xanthii Fructus.

Discussion and consideration on special decoction method for Chinese materia medica (III): Decoction wrapped / 中草药

“Decoction wrapped” is one of the characteristics of the special decoction of Chinese material medica. However, Some people have a certain misunderstanding or lack of basic knowledge about Chinese material medica for “decoction wrapped”, leading to the bad clinical effect or even side effects because of improper decoction. This study attempts to analyze the causes and attentions of Chinese materia medica for decocting based on multiple literatures, and put forward exploratory thinking on Methods: for decoction wrapped in order to provide scientific evidence for promoting clinical rational decoction for Chinese materia medica.

Discussion and consideration on special way of taking Chinese materia medica (I): Guiding herbs / 中草药

"Guiding herbs" is one of the characteristics of the special way of taking Chinese materia medica (CMM). However, some people have misunderstanding or lack of basic knowledge about how to choose the guiding herbs and its effect, leading to the poor clinical effect or even toxic effects because of improper decoction. This study attempts to analyze the action of the common guiding herbs in the Chinese Pharmacopoeia (2015 edition) from the perspective of reducing toxicity and increasing efficacy, returning drug to its channels, and put forward exploratory thinking on how to choose the guiding herbs to provide scientific evidence for promoting the rational use of drugs in clinic.

Medication rules of Professor Zhang Bing in treatment of skin itching based on data mining / 中国中药杂志

Skin itching is a subjective sensation that causes the desire to scratch. It is one of the most common clinical symptoms at department of dermatology, even the only complaint of dermatological patients, which seriously affects the quality life of patients. Therefore, based on the software of traditional Chinese medicine inheritance auxiliary platform, association rules and complex system entropy clustering were adopted to collect and analyze Zhang Bing's prescriptions for skin itching, and get the drug use frequency and the relationship between drugs. Based on that, we could conclude the experience for skin itching. A total of 147 prescriptions were collected, 20 drugs with a frequency of 34 or more and 20 high-frequency drug combinations were analyzed, and 14 core combinations and 7 new prescriptions were excavated. The high-frequency drugs included Kochiae Fructus, Dictamni Cortex, Mori Cortex. The high-frequency drug combinations included "Kochiae Fructus-Dictamni Cortex" "Angelicae Dahuricae Radix-Chuanxiong Rhizoma" "Paeoniae Radix Rubra-Paeoniae Radix Alba", and the core combinations included "Schizonepetae Herba-Saposhnikoviae Radix-Cinnamomi Ramulus" "Arctii Fructus-Cicadae Periostracum-Houttuyniae Herba" "Ghrysanthemi Indici Flos-Kochiae Fructus-Dictamni Cortex", and new formulations include "Schizonepetae Herba, Saposhnikoviae Radix, Cinnamomi Ramulus, Clematidis Radix et Rhizoma, Tribuli Fructus, Dictamni Cortex", "Phellodendri Chinensis Coritex, Lonicerae Japonicae Flos, Atractylodis Rhizoma, Ghrysanthemi Indici Flos, Kochiae Fructus, Dictamni Cortex" "Arctii Fructus, Cicadae Periostracum, Houttuyniae Herba, Trichosanthis Fructus". The result of this research shows that Professor Zhang Bing's experience in the treatment of skin itching is mainly to dispelling wind and arresting itching, clearing heat and drying dampness.

Preliminary application of optical surface monitoring system in intensity-modulated radiotherapy for thoracic tumors / 中华放射医学与防护杂志

Objective To investigate the accuracy and application value of optical surface monitoring system in intensity modulated radiotherapy for thoracic tumors patients.Methods Twenty-eight patients with thoracic tumors were included.During each treatment fraction,the patients were immobilized with body surface markers and laser lamps.The surface images obtained by the optical surface monitoring system were registered with the reference images and recorded during the CBCT scan.The translation and rotation errors of x (left-right),y (craniocaudal) and z (anterior-posterior) axes were recorded.After scanning,the CBCT images were registered with the planned CT images and the translation and rotation errors of x,y and z axes were recorded.The setup errors of these two image systems were analyzed and corrected before each treatment.The correlation between the two sets of setup errors were analyzed with Pearson test,and systematic error (∑) and random error (σy) were also calculated.The consistency of the two image systems was evaluated with the Bland-Altman method and the 95％ limits of agreement were calculated.Results There was a good correlation between these two groups,and the correlation coefficients were 0.79,0.62,and 0.53 in x,y and z axes,respectively.The ∑/σr of the optical surface monitoring system were 0.7 mm/1.5 mm,0.9 mm/1.8 mm and 0.9 mm/1.5 mm in x,y and z axes,respectively.The ∑/σ of CBCT were 0.8 mm/1.6 mm,1.3 mm/1.9 mm and 0.7 mm/1.5 mm in x,y and z axes,respectively.The 95％ limits of agreement of translations direction were (-2.0-2.3),(-3.4-3.6) and (-3.3-2.4) mm,and the 95％ limits of agreement of rotation direction were (-2.0 to 1.6)°,(-2.0 to 1.4)° and (-1.6 to 1.6)° inx,y and z axes,respectively.Conclusions The optical surface monitoring system is an effective image guide tool,which can quickly and accurately verify the patient's position and improve the position accuracy.It can be applied for positioning in the intensity modulated radiation treatments for the thoracic tumor patients.

Discussion and consideration on special decoction method for Chinese materia medica (I): Decoction first / 中草药

"Decoction first" is one of the characteristics of the special decoction of Chinese materia medica (CMM). However, some people have misunderstanding or lack of basic knowledge about the CMM for decoction first leading to the poor cruative effect or even toxic effects because of improper decoction. This study attempts to analyze the causes of CMM for decocting first from the perspective of reducing toxicity and increasing efficacy, discuss its matters needing attention from the point of view of the effect of decoction time and crushing degree on the decoction first based on ancient and modern literature, and put forward exploratory thinking on methods for decocting first in order to provide scientific evidence for promoting clinical rational decoction for CMM.

Discussion and consideration on special decoction method for Chinese materia medica (II): Decoction later / 中草药

“Decoction later” is one characteristic feature of the special decoction of Chinese materia medica (CMM). However, some patients have misunderstanding or lack of basic knowledge about CMM for “decoction later” leading to the bad clinical effect or even toxic effects because of inappropriate decoction. This study attempts to analyze the causes of CMM for decoction later based on ancient and modern literatures, and put forward exploratory thinking on methods for decoction later in order to provide scientific evidence for promoting clinical rational drug use for decoction later of CMM.

Discussion and consideration on safety of Sophorae Tonkinensis Radix et Rhizoma and its rational use / 中草药

Sophorae Tonkinensis Radix et Rhizoma is known as the important drug for treating sore throat and is widely used in clinic. Because of the coexisting of its efficacy and poison, Sophorae Tonkinensis Radix et Rhizoma often leads to a series of safety problems in the clinical application process. In this study, we attempt to analyze the ultimate cause of the toxicity of Sophorae Tonkinensis Radix et Rhizoma by reviewing nearly 20 years of literature, discuss the substance of its efficacy/toxicity from the point of view of chemical composition, and put forward exploratory thinking on its clinical rational application.

Historical evolution and rational use of Asari Radix et Rhizoma / 中草药

Asari Radix et Rhizoma has been used for more than 2000 years with wide application in medicine. In recent years, there are many poisoning cases of Asari Radix et Rhizoma being reported in clinic, the rational application in clinic of Asarum Radix et Rhizoma has been widely concerned due to its poisonous componets of safrole and aristolochic acid. The present paper traces the historical evolution of Asari Radix et Rhizoma through accessing Web of Science and multiple databases for biomedicinal sciences, and analyzes the characteristics of its toxic reaction, and discusses the matters needing attention in its rational application from the perspective of chemical composition, so as to promote the safe and reasonable application of Asari Radix et Rhizoma.

Prostate Cancer Prevention Trial risk calculator for evaluating the risk of prostate cancer in the high-risk Chinese population / 中华男科学杂志

Objective@#The Prostate Cancer Prevention Trial risk calculator (PCPT-RC) is an online tool for assessing the risk of prostate cancer (PCa) based on age, race, serum PSA, biopsy history, family history, and other factors. This study aimed to investigate the value, sensitivity and specificity of the PCPT-RC 2.0 in assessing the risk of PCa in the Chinese high-risk population.@*METHODS@#This study included 622 patients with the high risk of PCa characterized by high serum PSA (PSA >3 μg/L) or abnormality in digital rectal examination or imaging of the prostate. According to the results of prostate biopsy, we divided the patients into a PCa and a non-PCa group and used the PCPT-RC 2.0 for evaluation of all the cases followed by statistical analysis.@*RESULTS@#PCa was detected in 264 (42.4%) of the 622 patients, including 126 cases of high-grade malignancy. Compared with the non-PCa group, the PCa patients showed a significantly older age (［68.40 ± 7.30］ vs ［72.80 ± 7.20］ yr, P 0.05).@*CONCLUSIONS@#The PCPT risk score is valuable in predicting the risk of PCa in China, which may play a better role than the serum PSA level in screening PCa and avoid unnecessary prostate biopsy, though its advantage is not so obvious in identifying high-grade malignancy. A prediction tool needs to be established for evaluating the risk of PCa in the Chinese population.

The analysis on clinical characteristics and risk factors in patients with sepsis-associated pulmonary hypertension / 中华急诊医学杂志

Objective To analyze clinical characteristics and risk factors of pulmonary hypertension (PH) in patients with sepsis.Methods According to retrospective analysis of clinical data 136 cases with sepsis were divided into PH group and non-PH group.The clinical data,laboratory findings and ultrasonic cardiographic findings were recorded and compared between two groups.Multi-factors Logistic regression analysis was performed to find the independent risk factors of PH in patients with sepsis,and receiver operating characteristic curve ROC was constructed to indicate the predictable value.Results Of 136 patients with sepsis,32 (23.5％) developed PH.The PH group had higher NT-proBNP [lgNT-proBNP (3.67±0.41) vs.(3.33±0.59),P=0.003],higher E peak [(86.12±30.43) vs.(67.73±21.49),P=0.008],higher E/A peak [(1.09±0.46) vs.(0.83±0.29),P=0.014],higher left atrium diameter (LAD) [(36.49±5.97) vs.(31.32±4.69),P=0.001] and lower oxygenation index [(291.90±51.62) vs.(326.40±88.16),P=0.017] than the non-PH group (P ＜ 0.05).It was shown by multi-factors Logistic regression analysis that LAD (OR=1.198,P=0.010) was an independent risk factor of PH in patients with sepsis.The area under the curve AUC of LAD was 0.723,with the cut-off value of 31 mm (sensibility 82.6％,specificity 49.0％).Conclusions LAD was an independent risk factor of sepsis-associated pulmonary hypertension in sepsis patients.

The value of serum N-terminal pro brain natriuretic peptide in predicting left ventricular diastolic dysfunction in septic shock patients / 中华急诊医学杂志

Objective To investigate the predictive value of serum N-terminal pro brain natriuretic peptide NT-proBNP in left ventricular diastolic dysfunction(LVDD) in septic shock patients.Methods According to retrospective analysis of clinical data 96 patients with septic shock were divided into LVDD group and non-LVDD group.General clinical data,APACHE scores,NT-proBNP,Troponin I(TNI),creatinine,procalcitonin,D-dimer and lactic acid within the first 24 hours after admission were recorded,and multi-factors logistic regression analysis was conducted to find independent risk factors for left ventricular diastolic dysfunction in septic shock patients Receiver operating characteristic curve ROC was constructed to indicate the predictive value.Results There were no significant differences in general clinical data,procalcitonin,D-dimer and lactic acid between two groups.Compared with non-LVDD group the levels of NT-proBNP [lgNT-proBNP (3.66±0.38) vs.(3.03±0.59),P =0.000],TNI [lgTNI(-1.45±0.86)vs.(-2.36±0.82),P ＜ 0.01] and creatinine [(186.12±124.24)vs.(101.16±57.01),P ＜ 0.01] in LVDD group were significantly higher.It was shown by multi-factors logistic regression analysis that NT-proBNP (OR=8.731,95％CI;1.541-49.466,P=0.014) was an independent risk factor for left ventricular diastolic dysfunction in septic shock patients.The area under the curve AUC of NT-proBNP was 0.813 with the cut-off value of 1 725 pg/μL,sensibility =88.6％,specificity =62.1％.Conclusion NT-proBNP was avaluable indicator in predicting left ventricular diastolic dysfunction in septic shock patients.

Analysis of setup errors during radiotherapy for breast cancer patients immobilized with neck and breast thermoplastic mask / 肿瘤研究与临床

Objective To analyze the setup errors by cone-beam computed tomography (CBCT) for breast cancer patients who were immobilized with neck and breast thermoplastic mask and received intensity modulated radiation therapy (IMRT), and to calculate the external margins from the clinical target volume (CTV) to the planning target volume (PTV) (MPTV) of tumors. Methods Twenty-five breast cancer patients who were immobilized with neck and breast thermoplastic mask and received IMRT in the Oncology Department of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from November 2016 to June 2017 were enrolled. The position of the patients were verified by CBCT before treatment . The linear and rotation errors of the X, Y and Z axes were analyzed by online bone registration. The systematic errors (Σ) and random errors (σ) of the patients were also calculated, and then the margins from CTV to PTV margins were calculated based on MPTV=2.5Σ+0.7σ. 25 patients'height, weight, body mass index (BMI) and the maximum diameters of CTV in the lateral, longitudinal and vertical directions were recorded, and the relation between the setup errors and the above mentioned was analyzed by using Spearman method. Results A total of 174 CBCT scans for 25 breast cancer patients were completed. The group Σ were 1.40 mm, 1.50 mm and 1.20 mm, and rotation errors were 0.9°, 0.7° and 0.8° at the X, Y and Z axes, respectively. The group σ were 2.20 mm, 3.00 mm and 1.40 mm, and rotation errors were 0.7°, 0.6° and 0.7° at the X, Y and Z axes, respectively. MPTVwas recommended as 4.90 mm, 6.00 mm and 3.90 mm at the X, Y and Z axes, respectively. There was no correlation between the height, weight, BMI of the patients and the setup errors (all P ＞ 0.05). However, there was a significant correlation between the maximum lateral, longitudinal diameters of the CTV and the setup errors (rs= 0.406, P= 0.044; rs= 0.512, P= 0.009). Conclusions The neck and breast thermoplastic mask can improve the diagnostic accuracy of radiotherapy in breast cancer patients. The data of setup errors verified by CBCT can provide meaningful references for the setting of MPTV.