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Objective To quantify the setup errors for the different anatomical sites of patients who received intensity-modulated radiotherapy (IMRT) with linear accelerator on-board kilovolt fan beam CT(kV-FBCT) as non-isocenter IGRT and megavolt cone beam CT (MV-CBCT) as isocenter IGRT. Methods A retrospective analysis was performedon 70 patients who underwent radiotherapy, kV-FBCT, and/or MV-CBCT scans after each routine setup prior to IMRT. The average displacement (M), systematic error (Σ), and random error (б) at different treatment sites in the left-right, anterior-posterior, and cranial-caudal directions were calculated according to the individual displacements. The formula 2.5Σ+0.7б was used to estimate the PTV margin in respective direction. For each single patient, the root mean square in three directions was used as 3D displacement. Results A total of 1130 displacements were recorded in the 70 patients. The PTV margin was estimated to be 1.9-3.1 mm in head and neck cancer, 2.8-5.1 mm in thoracic cancer, 4.6-5.1 mm in breast cancer, 3.0-5.5 mm in upper abdominal cancer, and 3.5-6.8 mm in pelvic tumor. For the 3D mean displacements, the head and neck, thoracic, breast, upper abdominal, and pelvic cancer were 2.4±1.0, 4.0±1.6, 4.1±2.0, 4.6±2.1, and 4.6±2.1 mm, respectively. The average 3D displacement obtained by kV-FBCT and MV-CBCT were 4.1 and 3.4 mm, respectively (P=0.212). Conclusion The quantitative setup-error data can be obtained using linear accelerator on-board FBCT, and the non-isocenter IGRT induced set-up error cannot be negligible.
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Objective To analyze the changing antibiotic resistance profile of the Klebsiella pneumoniae strains isolated from blood cultures during the last 9 years in our hospital for rational use of antibiotics. Methods Antibiotic resistance of the K. pneumoniae strains isolated from blood cultures from 2009 to 2017 was retrospectively analyzed. Medical records of the corresponding inpatients were reviewed and analyzed. Results A total of 6 917 bacterial strains were isolated from blood cultures between 2009 and 2017, of which 311 strains (4.5％) were Klebsiella pneumoniae. Complete antimicrobial susceptibility data were available for 298 of the 311 strains. The K. pneumoniae strains isolated from blood cultures showed increasing resistance rate to the antimicrobial agents in the nine-year period. The resistance rates to piperacillin-tazobactam, cefotetan, amikacin, carbapenem antibiotics increased from 0 to 48.6％. The prevalence of CRKP increased from 0 in 2009 to 48.7％ in 2017. The inpatients with K. pneumoniae isolate from blood cultures were mainly found in general surgery, cardio-thoracic surgery department, emergency room, and pediatrics surgery department. Significant difference was found between CRKP-associated inpatients and non-CRKPassociated inpatients in the time to detection of K. pneumoniae, exposure to antimicrobial agents, invasive procedure, length of hospital stay, and prognosis (P＜0.001). Conclusions The antibiotic resistance profile of the K. pneumoniae strains isolated from blood cultures showed a rising tendency during the period from 2009 to 2017. Clinical microbiology laboratory should pay more attention to strengthening antibiotic resistance surveillance. Clinicians should reduce the use of invasive procedures and use appropriate antimicrobial agents to prevent the emergence of antibiotic-resistant strains.
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Objective To investigate the mechanism of IL-1β in promoting glial scar formation after spinal cord injury.Methods The experimental model of SCI was created by extradural compression of the spinal cord using an aneurysm clip.Rats were randomly divided into model group, sham operation group, IL-1β inhibitor IL-1RA group, IL-1β group and IL-1β+JAK2-STAT3 inhibitor AG490 group, according to different interventions, then were given normal saline, IL-1RA, IL-1β and IL-1β+AG490 every 10 μL respectively, sham group received only laminectomy.The motion function of the hindlimbs of rats was measured by Basso Beattie Bresnahan(BBB) scores and the expression of GFAP, vimentin and p-STAT3 were detected by Western blot technique, immunofluorescence assay and immunohistochemistry technique at corresponding time points(at the 8th, 12th hour, 1st, 3rd, 7th and 14th day after SCI).Results The expression trend of p-STAT3(at the 8th and 12th hour after SCI),GFAP and vimentin(at the 7th and 14th day after SCI)was: the expressions of p-STAT3, GFAP and vimentin in the model group were significantly higher compared with the sham group(P<0.01), the expression of p-STAT3,GFAP andvimentin in the IL-1RA group were significantly lower compared with the model group(P<0.05) whereas significantly higher compared with the sham group(P<0.05);the expressions of p-STAT3, GFAP and vimentin in the IL-1β+AG490 group were significantly lower compared with the model group(P<0.05)whereas significantly higher compared with the sham group(P<0.05), the expressions of p-STAT3, GFAP and vimentin in the IL-1β group were significantly higher compared with the model group(P<0.05).Conclusions IL-1β can improve glial scar formation via JAK2-STAT3 signal.Inhibition of IL-1β or JAK2-STAT3 can reduce glial scar formation and promote functional recovery of spinal nerve.
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Objective To investigate the prevalence and transmission route of Klebsiella pneumoniae carbapenemases ( KPC)-producing Klebsiella pneumoniae in Xinhua Hospital Affiliated to Shanghaijiao Tong University School of Medicine .Methods Carbapenem-resistant Klebsiella pneumoniae isolates from clinical samples were collected from Xinhua Hospital during January 2010 and December 2013.Vitek 2 Compact and disc diffusion method ( Kirby-Bauer method ) were used for identification of the strains and antibiotic susceptibility test . Modified Hodge test was performed for drug-resistant phenotype screening . Carbapenemase gene blaKPC was amplified by PCR, and the positive products were sequenced and analyzed . Enterobacterial repetitive intergenic consensus ( ERIC )-PCR was used to analyze molecular epidemiology of the KPC-producing strains .And clinical information of these isolates was analyzed .Results There were 77 carbapenem-resistant Klebsiella pneumoniae isolates in total , and 71 of them were positive in modified Hodge test.Sixty-nine isolates were identified carrying blaKPC-2 gene.All of the KPC-2-producing isolates were classified as the same genotype by ERIC-PCR. Among 12 patients with KPC-2-producing Klebsiella pneumoniae infection who were first identified in each departments , 7 were transferred from other departments, and 4 were treated in surgery intensive care unit (SICU).Conclusions Most of carbpenem-resistant Klebsiella pneumoniae strains isolated from Xinhua Hospital are KPC-2-producing .The outbreak of carbpenem-resistant Klebsiella pneumoniae infection in the hospital may be associated with the interdepartmental transfer of patients .
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Objective To study carbapenem-resistant genes in a Myroides odoratimimus strain and clinical therapy.Methods A strain of Myroides odoratimimus was isolated from nephrostomy drainage fluid of a patient with urinary tract infection in Xinhua Hospital in May 2013.MicroflexTM MALDI-TOF MS and 16S rDNA sequencing were performed for strain identification.Vitek-2 Compact combined with E-test method was used for antibiotic susceptibility test.Modified Hodge test and imipenem/imipenem-inhibitor (IP/IPI)E-test were performed for drug-resistant phenotype screening.Carbapenemase genes blaMUS-1,blaVIM-1,blaVIM-2,blaIMP-1,blaIMP-2,blaNDM-1,blaOXA-48 and blaGESwere amplified by PCR,and the positive products were sequenced and analyzed.Results The isolated strain was identified as Myroides odoratimimus.The strain was resistant to 17 antibacterial agents,and the minimum inhibitory concentration (MIC) of imipenem was ≥ 16 μg/mL,while it was sensitive to minocycline (MIC =0.38 μg/mL) and intermediate to meropenem (MIC =6 μg/mL).It was negative in modified Hodge test but positive in IP/IPI E-test (IP/IPI≥ 8).blaMUS-1 gene was detected by PCR,and further confirmed by sequencing.Meropenem combined with minocycline was effective for the patient.Conclusion Carbapenem-resistance in this Myroides odoratimimus strain may be related to blaMUS-1 gene,and appropriate therapy for its infection should be based on the result of antibiotic susceptibility test.
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Objective To evaluate and compare yeast identification ability between Bruker Microflex matrix-assisted laser desorption ionization-time of flight mass spectrometry( MALDI-TOF MS) and Vitek 2 Compact automatic microbial analysis system.Methods Retrospective study.Totally 742 strains of yeast isolated from clinical specimens during March 2013 to March 2014 in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine were identified by Bruker Microflex MALDI-TOF MS and Vitek 2 Compact automatic microbial analysis system simultaneously.The strains with discordant results were validated by gene sequencing.Results The coincidence rate of 699 Candida identified by Bruker Microflex MALDI-TOF MS or Vitek 2 Compact system was 100.0%(699/699) and 99.6%(696/699) to the species level, respectively and the coincidence rate of 43 yeast-like fungi strains identified was 90.7%(39/43) and 79.1%(34/43) to the species level, respectively.Penicillium marneffei could not be identified by both two instruments, but protein profile of Penicillium marneffei by MALDI-TOF MS was established.Conclusions The coincidence rate of yeast identified by Bruker Microflex MALDI-TOF MS is higher than that of Vitek 2 Compact system.Using Bruker Microflex MALDI-TOF MS to identify yeast especially Candida and yeast-like fungus is fast, simple, low-cost, accurate, and it can be used in routine work of ordinary yeast identification in clinical microbiology laboratory.
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Objective To study the effect of tubular stomach reconstruction on respiratory function and serum vascular endothelial growth factor(VEGF) level in patients with esophageal cancer.Methods 84 patients with esophagealcancer were randomIy divided into two groups.42 patients in the observation group were operated through tubular stomach reconstruction,while 42 patients in the control group were operated through full stomach and esophagus reconstruction of digestive tract.The respiratory function and serum VEGF were detected in all patients.Results The respiratory function was significantly declined after operation compared with before operation (P ＜ 0.05).The respiratory function was significantly improved postoperative two months compared with before operation (P ＜ 0.05,P ＜0.01),there was a significant difference between the two groups (P ＜ 0.05).Serum VEGF level was significantly decreased after operation in both two groups (P ＜ 0.0 1).Serum VEGF level of the observation group was significantly lower than that of the control group (P ＜ 0.05).Conclusion Tubular stomach reconstruction can improve respiratory function and prognosis of patients with esophageal cancer.
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BACKROUND:Previous studies have confirmed that radiofrequency ablation(RFA)has not only efficiently killed tumor cells,but also improved immune suppression of organism.Antigen presenting cells play an important role during anti-tumor immune reaction.Dendritic cells are most powerful antigen presenting cells.OBJECTIVE:To study the influence of RFA on OX-62,OX-6 and CD86 expression of rat peripheral blood mononuclear cells.DESIGN,TIME AND SETTING:The randomized controlled animal observation was performed at the School of Oncology of Peking University from June 2005 to March 2006.MATERIALS:A total of 12 Sprague Dawley rats were equally and randomly assigned into control and 1 -week radiofrequency groups.METHODS:2 mL peripheral blood was extracted from rats of the control group following rats were sacrificed.The left lobe of rat liver was exposed,inserted with acicular electrodes at tilted position.The acicular electrodes were spread out.The action time was 4 minutes.After RFA,the rats were given anti-infective therapy.2 mL peripheral blood was taken out after they were put to death 1 week after RFA.MAIN OUTCOME MEASURES:The following parameters were measured:pathomorphological observation on the liver of normal rats after RFA;OX-62,OX-6 and CD86 expression of peripheral blood mononuclear cells before and after RFA.RESULTS:Pathologyical examination after RFA showed the characteristic that coagulation necrosis and cellular degeneration and granulation tissue forming appeared from target center to peripheral of the target.Positive expression rate of OX-62 in rat peripheral blood in the 1-week radiofrequency group[(0.70±0.16)%]was significantly higher than in the control group [(0.34±0.08)%,P ＜0.05].No significant difference in positive expression rate of OX-6 and CD86 in the peripheral blood mononuclear cells between both groups(P＞0.05).CONCLUSION:RFA can promote the increased number of precursor Dendritic cells in rat peripheral blood,which may be contributed to improve the ability to angtigen presentation during immune response.Dai Wei-de,Doctor,Associate chief physician,Department of Ultrasound,Beijing Hospital of Ministry of Public Health,Beijing 100730,China dai.weide@126.com