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Objective: To investigate the characteristics of pharmacokinetic (PK) and pharmacodynamic (PD) parameters of antibacterial agents in children with sepsis treated by extracorporeal membrane oxygenation (ECMO). Methods: In this prospective cohort study, 20 children with sepsis (confirmed or suspected) who were treated with ECMO and antimicrobial in the Department of Critical Medicine of Hunan Children's Hospital from March 2021 to December 2022 were enrolled as the ECMO group. Through therapeutic drug monitoring (TDM), the PK-PD parameters of antibacterial agents were analyzed. Twenty five children with sepsis in the same department who were treated with vancomycin but no ECMO at the same time were enrolled as the control group. The individual PK parameters of vancomycin were calculated by Bayesian feedback method. The PK parameters in the two groups were compared, and the correlation between trough concentration and area under the curve (AUC) was analyzed. Wilcoxon rank sum test was used for inter group comparison. Results: Twenty patients in the ECMO group, included 6 males and 14 females, with an onset age of 47 (9, 76) months. In the ECMO group, 12 children (60%) were treated with vancomycin, and the trough concentration was less than 10 mg/L in 7 cases, 10-20 mg/L in 3 cases, and >20 mg/L in 2 cases; AUC/minimum inhibitory concentration (MIC) (MIC=1 mg/L)<400 was in 1 case, 400-600 in 3 cases, and >600 in 8 cases. Among the 11 children (55%) who were treated with β-lactam antibiotics, there were 10 cases with drug concentration at 50% dosing interval (CT50)>4 MIC and 9 cases with trough concentration>MIC, both CT50 and trough concentration of cefoperazone reached the target. Among the 25 cases of control group, 16 were males and 9 females, with an onset age of 12 (8, 32) months. There was a positive correlation between vancomycin trough concentration and AUC (r2=0.36, P<0.001). The half-life of vancomycin and the 24-hour AUC (AUC0-24 h) in the ECMO group were higher than those in the control group (5.3 (3.6, 6.8) vs. 1.9 (1.5, 2.9) h, and 685 (505, 1 227) vs. 261 (210, 355) mg·h/L, Z=2.99, 3.50, respectively; both P<0.05), and the elimination rate constant and clearance rate was lower than those in the control group (0.1 (0.1, 0.2) vs. 0.4 (0.2, 0.5), 0.7 (0.5, 1.3) vs. 2.0 (1.1, 2.8) L/h, Z=2.99, 2.11, respectively; both P<0.05). Conclusion: The PK-PD parameters in septic children treated by ECMO varied with a longer half-life, higher AUC0-24 h, lower elimination rate constant and clearance rate.
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Female , Male , Humans , Child , Child, Preschool , Infant , Anti-Bacterial Agents/therapeutic use , Vancomycin/therapeutic use , Bayes Theorem , Extracorporeal Membrane Oxygenation , Prospective Studies , Sepsis/drug therapyABSTRACT
Background@#The public now imposes higher demands on the government than in the past, which has created the role overload faced by low-ranking government employees in China. This research investigates the relationship between role overload and health among low-ranking government employees and explores the mediating effects of burnout. @*Methods@#It draws on a survey of 2064 low-ranking government employees by probability proportionate to size sampling in China's Shandong Province. Structural equation modeling (SEM) methods are used to analyze the data. @*Results@#Both role overload and burnout were found to have negative effects on low-ranking government employees' health; however, the associations varied among the three age groups (less than 36, between 36 and 45, and over 45). Those over 45 reported the highest level of both physical and psychological health, while the youngest age group (less than 36) reported the lowest level of health. Role overload has a direct influence on health among government employees over 45 but not among those below 45. Burnout's mediating effects between role overload and health are significant among all age groups, but most significant among the youngest civil servants below 36. @*Conclusions@#The findings evidenced that both role overload and burnout affect low-ranking government employees' self-reported physical and psychological health. In addition, the effect of age differences in coping with role stressors and burnout should be considered.
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Objective:To study the impact on dose accuracy for the treatment planning by manually assigning accurate electron density for CT image-based tumor tissues and organs at risk.Methods:Twenty cases of retrospective postoperative cervical cancer radiotherapy plans were selected. The body electron density of the corresponding organs was derived from the ICRU 46 report and assigned in the treatment planning system (Monaco5.11, Sweden), including the bladder, rectum, intestine, kidney, spinal cord, femoral head, and ilium. The original plans were double-arc volumetric modulated arc therapy plan (360° VMAT), using Monte Carlo algorithm, the calculation grid was 0.3 cm × 0.3 cm × 0.3 cm, and the minimum subfield width was 0.6 cm. Keep the original plan fluence unchanged and recalculate the dose to generate a new plan. The two-dimensional dose distribution and dose-volume histogram (DVH) were used to compare the differences between the two plans. The difference was compared between the two group plans by using the dosimetry parameters and DVH two dimension curve.Results:For the planning of assigning bulk electron density (Plan RED), the deviation of the patient′s target dose parameters and the original plan (Plan ref) was <2%, and the average deviation of all target regions D2, D98, Dmean was < 0.7%, only 2 of the 180 data were between 2% and 3%. The average deviation of V20, V30, D1 cm 3, Dmean of the bladder, rectum, and small intestine, the original Plan ref was less than 0.6%, and 4 out of 240 data had values > 2%. Plan RED′s average hop count was 0.9% higher than Plan ref, and the total number of subfields remains unchanged. The planned dose generated by manually assigning the electron density in Plan RED was higher than that in Plan ref, but met the clinical requirements. The two-dimensional curves of the DVH diagram for targets and OARs almost completely overlapped, and there was no obvious difference in the dose distribution diagram of the same cross section. The statistical result of all parameters showed that the difference in planned dose parameters between the two groups was not statistically significant( P>0.05). Conclusions:The overall deviation of dose accuracy between Plan RED and Plan ref is <2%, which meets the clinical requirements and provides a reference for realizing MRI-only treatment planning.
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Turner syndrome(TS)results from a sex-chromosomal anomaly characterized by presence of one normal X chromosome and the loss of the second X-chromosome in phenotypic females.The typical clinical manifestations of Turner syndrome are short stature, hypogonadal dysplasia, and special physical characteristics(such as neck web, shield chest, elbow valgus, etc.). And it is related to the risk of autoimmune diseases, such as autoimmune thyroiditis, celiac disease, type 1 diabetes, inflammatory bowel disease, alopecia areata or vitiligo.This review will address the autoimmune disorders associated with TS, their pathophysiologic mechanisms and clinical characteristics.
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Objective@#To investigate the Offset values of different applicators in afterloading brachytherapy.@*Methods@#Six types of applicators were selected in this study which included stainless steel interstitial needle (Part#083.062), proguide round needle (Part#189.608), proguide sharp needle (Part#189.601), vaginal multi-channel applicator (Part#110.800), fletcher CT/MR applicator (Part#189.745) and henschke titanium applicator (Part#110.437). According to the sources imaging in the fluorography film, the distance of applicators between the first dwell position and the top could be measured. Marker was pasted on the surface of applicator corresponding to the first dwell position. And then the applicator was put into the pelvic phantom for a CT scan. During applicator reconstruction in the treatment planning system, the Offset values of all applicators could be acquired through adjusting the value of offset to superimpose the first dwell and the marker images. On account of the density of plastic material applicators were similar to human tissues, it was difficult to reconstruct the top of the applicator. With the help of stopper or simulation source, the value of offset could be acquired for plastic material applicators. Based on the measurement results, the differences were analyzed among different applicators.@*Results@#The Offset values significantly differed among various applicators. The Offset value for stainless steel interstitial needle was -11.4 mm, -4.1 mm for proguide round needle, -3.5 mm for proguide sharp needle, 0 mm or -5.0 mm for vaginal multi-channel applicator, -6.5 mm for fletcher CT/MR applicator and -7.5 mm for henschke titanium applicator, respectively.@*Conclusion@#To adapt to the rapid development of precise radiotherapy, it is necessary to verify the Offset value in afterloading brachytherapy.
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Premature ovarian insufficiency(POI), previously known as premature ovarian failure(POF), is defined as the occurrence of premature ovarian failure in women under the age of 40 who may present with delayed puberty, primary or secondary(for 4 months or more)amenorrhea with two times and more of abnormal serum hormonal levels(low estradiol and raised gonadotrophins). And POI is not common in children and adolescents.It is generally believed that the etiologies of POI may be genetic, immunological, iatrogenic, etc.Hormone replacement therapy(HRT)is the primary treatment of POI in children and adolescents, and evaluation of therapeutic strategies to POI including cardiovascular, skeletal and emotional health is needed as well.Recently, the incidence of POI in children and adolescents has increased, therefore, early diagnosis and active treatment are urgent and necessary.Thus, this review will mainly be focused on the etiology and treatment of POI in children and adolescents.
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Objective To investigate the Offset values of different applicators in afterloading brachytherapy.Methods Six types of applicators were selected in this study which included stainless steel interstitial needle (Part#083.062),proguide round needle (Part#189.608),proguide sharp needle (Part# 189.601),vaginal multi-channel applicator (Part # 110.800),fletcher CT/MR applicator (Part # 189.745)and henschke titanium applicator (Part#110.437).According to the sources imaging in the fluorography film,the distance of applicators between the first dwell position and the top could be measured.Marker was pasted on the surface of applicator corresponding to the first dwell position.And then the applicator was put into the pelvic phantom for a CT scan.During applicator reconstruction in the treatment planning system,the Offset values of all applicators could be acquired through adjusting the value of offset to superimpose the first dwell and the marker images.On account of the density of plastic material applicators were similar to human tissues,it was difficult to reconstruct the top of the applicator.With the help of stopper or simulation source,the value of offset could be acquired for plastic material applicators.Based on the measurement results,the differences were analyzed among different applicators.Results The Offset values significantly differed among various applicators.The Offset value for stainless steel interstitial needle was-11.4 mm,-4.1 mm for proguide round needle,-3.5 mm for proguide sharp needle,0 mm or-5.0 mm for vaginal multi-channel applicator,-6.5 mm for fletcher CT/MR applicator and-7.5 mm for henschke titanium applicator,respectively.Conclusion To adapt to the rapid development of precise radiotherapy,it is necessary to verify the Offset value in afterloading brachytherapy.
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OBJECTIVE@#To investigate the incidence of congenital anomalies of the kidney and urinary tract (CAKUT) in neonates, and to evaluate the value of urinary ultrasound screening in the early postnatal period.@*METHODS@#The neonates born or treated in Beijing Tsinghua Changgung Hospital affiliated to Tsinghua University between January 2016 and December 2018 accepted the urinary ultrasound screening, and the neonates with problem were followed up. In the meanwhile, the maternal pregnancy data were analyzed to screen out the risk factors associated with the onset of CAKUT.@*RESULTS@#(1)A total of 2 655 neonates were screened by ultrasonography, of whom 82 neonates had been diagnosed with CAKUT (male: 60 cases, female: 22 cases), the positive rate was 3.1% (82/2 655). There were 66 cases of hydronephrosis, 6 cases of duplicate kidney, 2 cases of multiple renal cysts, 2 cases of renal cystic dysplasia, 1 case of medullary sponge kidney, 3 cases of small kidney, 1 case of isolated kidney, and 1 case of horseshoe kidney. (2)Of the 66 children with hydronephrosis, 4 cases were lost to the follow-up; 8 cases were followed for less than six months with no significant changes found, and still in the follow-up observation; 54 cases were followed up for 1 year, among which 32 cases were returned to normal within 1 year, 3 cases were alleviated, 7 cases were aggravated, and 12 cases were unchanged. One case underwent surgery for repeated urinary tract infections and decreased renal function. (3) Abnormal fetal urinary ultrasound in the late pregnancy was found to be the most common in the high risk factors of CAKUT. There were 44 high-risk newborns with abnormal fetal urinary ultrasound, and 35 cases of CAKUT were diagnosed after birth. The incidence rate was 79.5%(35/44). (4)Among the 2 655 newborns screened, 2 611 newborns had normal antenatal urinary ultrasonography. Among these neonates with normal urinary ultrasound during pregnancy,47 cases of CAKUT were diagnosed after birth, with an incidence of 1.8% (47/2 611).@*CONCLUSION@#The most common CAKUT in neonates is hydronephrosis and most cases with hydronephrosis had a good prognosis, but they should be followed up regularly. Urinary ultrasound screening for neonates, especially those high-risk neonates with abnormal fetal urinary ultrasound, has important clinical implications for the early detection of CAKUT.
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Child , Female , Humans , Infant, Newborn , Male , Pregnancy , Follow-Up Studies , Hydronephrosis , Kidney , Ultrasonography , Urinary TractABSTRACT
Kallmann syndrome (KS) is a rare pediatric disease with major manifestations of olfactory dysfunction and hypogonadotropic hypogonadism. Five children (4 boys and 1 girl) with KS reported in this article were aged between 6 months and 19 years at the time when they attended the hospital. All the children had the clinical manifestation of hypogonadotropic hypogonadism; in addition, three children had olfactory dysfunction (two were found to have olfactory bulb dysplasia on magnetic resonance imaging), one had cleft lip and palate, and one had micropenis and cryptorchidism with right renal agenesis during infancy. All the five children had normal karyotype and their parents had normal clinical phenotypes. The uncle of one child had underdeveloped secondary sexual characteristics and olfactory disorder since childhood. High-throughput sequencing found two known heterozygous missense mutations in the FGFR1 gene, i.e., c.1097C>T(p.P366L) and c.809G>C(p.G270A), in two children. One child had a novel frameshift mutation, c.1877_1887/p.S627Tfs*6, in the KAL1 gene; this deletion mutation caused a frameshift in base sequence and produced truncated proteins, which led to a significant change in protein structure, and thus it was highly pathogenic. It is concluded that KS has great clinical and genetic heterogeneity and can be accompanied by incomplete dominant inheritance and that gene detection helps with the diagnosis of this disease.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Young Adult , DNA Mutational Analysis , Extracellular Matrix Proteins , Heterozygote , Hypogonadism , Kallmann Syndrome , Mutation , Nerve Tissue Proteins , Receptor, Fibroblast Growth Factor, Type 1ABSTRACT
<p><b>OBJECTIVE</b>To report on two cases affected with immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome (IPEX).</p><p><b>METHODS</b>Two unrelated Chinese infants affected with IPEX were investigated. Case 1 was a 4-month-old boy with neonatal diabetes and severe enteropathy. Case 2 was a 6-day newborn boy with neonatal diabetes and ketoacidosis. DNA samples of the two infants and their parents were sequenced for FOXP3 gene mutations. Suspected mutations were verified among 100 unrelated healthy controls. The function of mutations was predicted with bioinformatics software.</p><p><b>RESULTS</b>Both infants had onset of the disease during neonatal period, and manifested insulin-dependent diabetes mellitus, persistent diarrhea, eczema and malnutrition. In case 1, a novel splice site mutation was identified in intron 9 (c.967+3A>T) of the FOXP3 gene, for which his mother was a carrier. For case 2, a missense mutation (c.1150G>A) was detected in exon 11 of the FOXP3 gene, for which his mother was also a carrier. The IVS9 c.967+3A mutation was not detected among the 100 healthy controls. As predicted with Human Splicing Finder software, the c.967+3A>T mutation may influence the splicing of mRNA and affect the function of protein.</p><p><b>CONCLUSION</b>Both cases had typical clinical manifestation of the IPEX syndrome, among whom a novel splice site mutation (IVS9 c.967+3A>T) and a missense mutation (c.1150G>A) of the FOXP3 gene were identified. The clinical manifestation of the IPEX syndrome may be variable and the mortality is high. FOXP3 gene sequencing is recommended when insulin-dependent diabetes mellitus is diagnosed during the neonatal period.</p>
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Childhood obesity is a complex disease that is caused by potygene inheritance and environmental factors.It is the main cause of obesity that energy intake is more than energy consumption.Neuroendocrine regulation participates in the pathogenesis of obesity.Nerve fibers are the basic structure and functional units of the nervous system.The study of the relationship between the distribution of nerve fibers and obesity in children may be a useful exploration for the pathogenesis of obesity.Diffusion tensor imaging (DTI) is a widely used magnetic resonance imaging (MRI) technique.It is a mature technique for observing human white matter fibers.It is an important technique to display the the tacts of the white matter,The diagnosis of the disease and the changes of the central nervous system can be deterined by describing the relationship between the white matter fibers and observing whether the integrity of the white matter is destroyed or not,so as to reflect the structure and function of the brain.But in obese children,the research is lacking.The application of DTI in childhood obesity research is reviewed in this article.
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Objective·To investigate the value of hypoxia-inducible factor 1α (HIF-1α) in diagnosis and prognosis of acute decompensated chronic heart failure (CHF).Methods·32 patients with acute decompensated CHF (Group A),33 patients with stable CHF (Group B) and 30 controls (Group C) were included.HIF-1α,B-type natriuretic peptide (BNP) and other biochemical indicators in blood were detected.Length of stay and readmission frequency within 3 months of Group A were recorded.Correlations between HIF-1α and other indicators were analyzed.ROC curves of HIF-1α and BNP were developed to compare their diagnostic values.Results·The HIF-1α and BNP levels of Group A were both significantly higher than those of Group B and Group C (P＜0.05).HIF-1α was positively correlated with serum creatinine,hemoglobin,BNP,length of stay and readmission frequency within 3 months (P＜0.05).Areas under curves of HIF-1α and BNP showed no statistically difference (P＞0.05).Conclusion·HIF-1 α has a certain value in diagnosis and prognosis of acute decompensated CHF.
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Objective: To investigate the value of hypoxia-inducible factor 1α (HIF-1α) in diagnosis and prognosis of acute decompensated chronic heart failure (CHF). Methods: 32 patients with acute decompensated CHF (Group A), 33 patients with stable CHF (Group B) and 30 controls (Group C) were included. HIF-1α, B-type natriuretic peptide (BNP) and other biochemical indicators in blood were detected. Length of stay and readmission frequency within 3 months of Group A were recorded. Correlations between HIF-1α and other indicators were analyzed. ROC curves of HIF-1α and BNP were developed to compare their diagnostic values. Results: The HIF-1α and BNP levels of Group A were both significantly higher than those of Group B and Group C (P0.05). Conclusion: HIF-1α has a certain value in diagnosis and prognosis of acute decompensated CHF.
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Objective To compare the dosimetric parameters between the use of Tandem and Ring (TR;Nucletron#090.617) or Tandem and Ovoid (TO;Nucletron#189.730) applicators during three-dimensional (3D) high-dose rate (HDR) brachytherapy (BT) for cervical cancer.Methods The records of 40 cervical cancer (ⅡB-ⅣA) patients treated with 3D-image-guided HDR-BT were reviewed.Of these 40 patients, 20 were treated with the TO applicator, and 20 with the TR applicator.The D100% and V150% of the clinical target volume (CTV) and the D2 cc of organs at risk (OAR)(the rectum, bladder, and small intestine) during 3D-HDR-BT using TO and TR were compared using the independent sample t-test.ResultsOverall metrics:CTV volume:66.04±13.86 cm3(TR) vs.65.67±15.08 cm3(TO)(P=0.052);CTV D100:3.71±0.34 Gy (TR) vs.3.37±0.49 Gy (TO)(P=0.016);CTV V150%:0.54±0.02(TR) vs.0.56±0.04(TO)(P=0.034);rectum D2 cc:3.38±0.30 Gy (TR) vs.2.95±0.80 Gy (TO)P=0.037);bladder D2 cc:4.33±0.39 Gy (TR) vs.2.93±1.27 Gy (TO)(P=0.00);and small ntestine D2 cc:3.04±1.02 Gy (TR) vs.3.41±0.57 Gy (TO)(P=0.171).Conclusions TR has better CTV coverage than TO during 3D HDR brachytherapy for cervical cancer.In addition, D2 cc of the rectum and bladder were both igher with TR than with TO, though there is no significant dosimetric difference in the small intestine between the two applicators.Therefore, tumor location, extent of invasion, and vaginal conditions should be considered when selecting the suitable pplicator for the treatment of cervical cancer.
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Objective To investigate the dosimetric influence of dwell weight standard deviation (DWSD) and applicator displacement in cervical cancer patients treated with three-dimensional brachytherapy.Methods A total of 20 cervical cancer patients who had completed radical treatment were selected in this study.The Fletcher applicator (Nucletron#189.730) was used for these patients.A new plan,based on the former CT images and structures,was designed for each patient.In former and new plans,dwell weight was recorded,and DWSD was calculated.Two groups,low-DWSD (LDWSD,0.141-0.299) and high-DWSD (HDWSD,0.211-0.337),were set according to the DWSD size for the two plans.Dosimetric effects from ± 1 mm displacement of tandem applicator or ovoid applicator were simulated with Oncentra (R) Brachy V4.3 treatment planning system.D100,D90,and V150 for clinical target volume (CTV)and D0.1cc,D1cc,and D2cc for the bladder,rectum,and sigmoid were evaluated.Dosimetric comparisons were made between the LDWSD group and HDWSD group to study the dosimetric effects of DWSD and applicator displacement in cervical cancer patients.Results The dosimetric effects from applicator displacement increased with increasing DWSD.If there was a 1 mm displacement of tandem applicator or ovoid applicator,D100,D90,and V150 of CTV were 3.0％,23.8％,and 4.8％ higher or 0.5％,1.2％,and 5.2％ higher in the HDWSD group than in the LDWSD group;D0.1cc,D1cc,and D2cc of the bladder and rectum were significantly higher in the HDWSD group than in the LDWSD group,particularly for the sigmoid (up 44.0％,22.8％,and 16.8％) and (up 10.3％,14.4％,and 12.4％).Conclusions DWSD should be considered in plan evaluation for cervical cancer patients treated with three-dimensional brachytherapy.The dosimetric influence from applicator displacement can be decreased by reducing DWSD properly.
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Objective To compare dosimetric parameters between automatic three-dimensional conformal radiotherapy (a3DCRT),inverse three-dimensional conformal radiotherapy (i3DRT),inverse intensity-modulated radiotherapy (iIMRT).Methods Ten lung cancer patients with a single target and 10 intracranial tumor patients also with a single target,who were treated in our radiotherapy center from 2014 to 2015,were included in the study.Their image data were transferred to RayStation 4.5 via network,and then the treatment plans for a3DCRT,i3DCRT,and iIMRT were designed for the 20 patients.The dosimetric parameters for planning target volume (PTV) and organs at risk (OAR) were compared between the three plans using multiple dependent variables and two dependent variables.Results For lung cancer patients,iIMRT achieved better results in D98％,D50％,D2％,conformity index (CI),and homogeneity index (HI) than i3DCRT and a3DCRT (P=O.007,0.001,0.002,0.000,and 0.000),and the CI of a3DCRT was superior to that of i3DCRT (P=O.000);there were no significant differences in heart D33,spinal cord Dmax and D1 cm3,and both lungs between the three plans (P=O.702,0.237,0.163,0.739,0.908,0.832,0.886,0.722,0.429,0.840,and 0.702).For intracranial tumor patients,there were no significant differences in dosimetric parameters between the three plans,except that the CI of iIMRT and a3DCRT was superior to that of i3DCRT (P=O.648,0.783,0.256,0.931,0.002,and 0.034);there were no significant differences in whole brain irradiation dose between the three plans (P=0.446,0.755,0.772,0.0266,0.440,0.290,and 0.939).Conclusions For the single target in patients with lung cancer and intracranial tumors,a3DCRT can improve the CI of PTV compared with i3DCRT,and shows no significant dosimetric disadvantage for OARs compared with iIMRT.Considering the simplicity and low cost of 3DCRT,a3DCRT holds promise as a novel radiotherapy technique.
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Objective To study the characteristics of neonatal sepsis caused by gram positive (G +) bacteria,gram negative (G+) bacteria and fungi.Method Clinical data of 202 neonates with sepsis hospitalized from Jan.2012 to May.2015 were studied.According to the different pathogens,202 neonates were divided into gram positive bacteria group,gram negative bacteria group and fungi group.The general information,clinical manifestation,laboratory examination and treatment outcome of the three groups were analysed with Chi square analysis,LSD,Fisher exact probability tests.Result A total of 202 cases of neonatal sepsis were recruited.The detection rate of gram positive bacteria,gram negative bacteria and fungi was 35.2％ (71 cases),56.4％ (114 cases) and 8.4％ (17 cases),respectively.Comparing with gram negative group and fungi group,gram positive group had older gestational age (36.0 ± 3.8 w,compared with gram negative 33.0 ± 3.9 w,fungi group 31.2 ± 3.2 w,P ＜ 0.05),larger birth weight (2 620 ± 925 g compared with gram negative group 1 999 ± 849 g,fungi group 1 595 ± 666 g,P ＜ 0.05),lower nosocomial infection rate (29.6％ compared with gram negative group 70.2％,fungi group 94.1％,P ＜0.05),lower rate of shock,blood glucose disturbance and thrombocytopenia (P ＜ 0.05).There was no statistics difference between the gram negative group and fungi group.Comparing with the other two groups,fungi group was older [20.0 (11.5,39.5) d compared with gram positive group 7.0 (2.0,17.0) d,and gram negative 10.0 (6.0,18.2) d,P ＜ 0.05].The rate of deep venous catheterization in fungi group was higher than that in gram positive group and gram negative group (88.2％ compared with gram positive group 25.4％,gram negative group 40.4％,P ＜0.05).The treatment course of fungi group was longer than that of the gram positive group and gram negative group [22.0 (12.0,37.5) d compared with the gram positive group 14.0 (10.0,17.0) d,gram negative group 14.0 (11.0,18.0) d,P ＜0.05].The incidence of apnea in the gram negative group was higher than that in gram positive group and fungi group (P ＜ 0.05).The rate of leukocytosis,leukocytopenia and elevated CRP were higher in gram negative and gram positive group (P ＜ 0.05).Conclusion The clinical manifestations and laboratory examinations in neonatal sepsis caused by different pathogens were different,which can help to early identification of different pathogenic infections.However,there is no specific indicators to differentiate neonatal sepsis caused by different pathogens.Early identification of the pathogen needs clinical acumen.
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Objective To compare the effective dose deposited in patients between helical tomotherapy (HT) and multi-ISO radiotherapy (M-ISO) in carniospinal irradiation (CSI).Methods Nine children with craniospinal irradiation were selected .For these patients , new plans were designed with HT and M-ISO centers planning method on the treatment planning system ( TPS) .The effective dose of the nine patients from 18 treatment plans were calculated ,and the difference of the effective dose between HT and M-ISO was compared using paired t-test.Results The plans designed in two groups were both satisfied all clinical requirements .For the planning target volume ( PTV ) , no statistically significant difference was found in D95% between two groups ( P>0.05 ) , while D98%, D2% and homogeneity index (HI) in HT group were superior to M-ISO group (t=2.762, 2.413, 4.563, P<0.05), D50%, Dmean and CI in M-ISO group were superior to HT group (t=5.259, 3.685, 7.815, P<0.05).HT and M-ISO had different advantages in the protection of the OARs .The effective dose of patients in M-ISO group was superior to HT group (t=5.921, P<0.05).Conclusions HT and M-ISO have different advantages in CSI.The low dose area has greater influence on the effective dose in HT group compared to M-ISO group. The low dose area should be concerned while designing the treatment planning for CSI .
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Objective To evaluate the impacts of slice thickness and registration frame range on the accuracy of cone-beam computed tomography ( CBCT) image-guided head and neck ( HN) radiotherapy, and to provide a basis for positioning correction in image-guided radiotherapy.Methods A planned CT scan was performed for an anthropomorphic HN phantom with slice thickness of 1 mm and 3 mm and simulated positioning errors in x, y, and z directions on the accelerator.CBCT scan and reconstruction were performed with slice thickness of 1 mm and 3 mm.Two different registration frame ranges were used ( range 1:from C7 to superior orbit;range 2:from C7 to calvaria ) .Automatic bony registration was performed for CBCT and planned CT images with slice thickness of 1 mm and 3 mm.The registration accuracy was evaluated.Results For range 1, the registration errors in x, y, and z directions with a slice thickness of 1 mm were significantly lower than those with a slice thickness of 3 mm (0.5±0.2 mm vs.-0.7±0.2 mm, P=0.00;0.5±0.3 mm vs. 1.0±0.3 mm, P=0.00;-0.1±0.5 mm vs.1.5±0.5 mm, P=0.00).For range 2, the registration errors in x, y, and z directions with a slice thickness of 3 mm were-0.4±0.2 mm, 0.5±0.2 mm, and 0.7±0.4 mm, respectively.Conclusions Engagement of calvaria in registration range can substantially enhance the registration accuracy in CBCT or CT images for HN.The registration error with slice thickness of 1 mm can be controlled within 1 mm.
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The present study was designed to determine the chemical constituents and identify new components of the leaves of Aquilaria sinensis (Lour.) Gilg. The compounds were isolated and purified by repeated silica gel, Sephadex LH-20, and ODS column chromatography and their structures were elucidated by NMR and HR-ESI-MS spectrometry. Eight megastigmane glycosides and two cucurbitacins were isolated and identified as (9S) megastigma-4,7-diene-2,3,9-triol 9-O-β-D-glucopyranoside (1), (9S) megastigma-4(13),7-diene-3,6,9-triol 9-O-β-D-glucopyranoside (2), macarangloside D (3), corchoionoside C (4), staphylionoside H (5), (+) 3-oxo-α-ionol-β-D-glucopyranoside (6), (-) 3-oxo-α-ionol-β-D-glucopyranoside (7), citroside B (8), 2-O-β-D-glucopyranosyl cucurbitacin I (9), bryoamaride (10). Compounds 1 and 2 were newly identified megstigmane glucosides and reported from this genus for the first time.