Research progress on bolus materials used for radiotherapy / 中华放射肿瘤学杂志

It is necessary to place bolus on skin to increase the surface dose when using high-energy rays to treat superficial lesions because of its build-up effect. It is well known that the set-up reproducibility of hand-made bolus is poor, and the main concern of commercialized bolus is the inadvertent air gap between the bolus and irregular skin. Owing to the advantage of making individualized and complex-shaped bolus, 3D-printing technology is playing an important role in making the bolus. The aim of this review is to summarize the current research status of hand-made, commercialized and 3D-printed bolus materials and future development trend of the bolus, providing reference for clinical application.

Time phased scheduling and Disease grading management to achieve efficient rescue of batches of COVID-19 infected patients in shelter hospital / 中华急诊医学杂志

Objective:To introduce how to quickly set up a doctor team to achieve efficient treatment of batchs COVID-19 patients in Changchun GongTi shelter hospital.Methods:A cross-sectional study was conducted to analyze the basic situation of the doctors who supported the Changchun Gongti shelter hospital. The workload is the total number of patients from April 3 to 28, 2022. At the beginning of the task, the first week and the third week of the task, the five point scoring method was used to reflect the doctor's physical and mental state, stress state and rescue achievement. The time phased scheduling and disease grading management were fully implemented after 10 days of operation in the shelter. The doctors' ward round efficiency and self scoring changes before and after the implementation of the plan were compared, and the rescue results were summarized.Results:Total of 56 doctors (the Sichuan medical assistance team to Changchun), who undertook the work of Changchun Gongti shelter Hospital, came from 12 professional departments of 14 hospitals. By internal and external linkage-time phased scheduling and information-based patient zoning and grading management, the admission time of batch patients was shortened from (14.64±10.09) min to (6.80±5.10) min per person( P<0.05), the number of patients that each doctor can view per hour ranges from (28.50±12.26) to (68.43±19.95) ( P<0.01). A total of 1 293 patients were treated. There were no deaths, no accidents and no mild illness to severe illness in shelter hospital. 35 doctors completed a continuous survey. Before and after the implementation of those measures, the average physical state scores and the psychological state scores of doctors improved ( P=0.03), the self-score of stress feeling decreased ( P<0.01), and the self-score of professional achievement increased ( P<0.01). Conclusions:To adapt to the characteristics of emergency treatment for batch COVID-19 patients, the internal and external linkage-time phased scheduling and information-based patient zoning and grading management could help the temporarily convened doctors deal with a large number of patients efficiently, reduce work stress and exposure risk in shelter hospital.

Pulmonary arteriovenous malformations and ischemic stroke / 国际脑血管病杂志

Pulmonary arteriovenous malformations (PAVMs) can induce cryptogenic stroke and are also an important cause of stroke in young adults. The risk of ischemic stroke increases with age in patients with PAVMs. Contrast echocardiography can be used for early screening of PAVMs, especially in young patients with cryptogenic stroke. After treatment, patients with PAVMs have a reduced risk of ischemic stroke. This article summarizes the etiology, pathogenesis, diagnosis and treatment of PAVMs by retrieving studies on PAVMs and ischemic stroke, in order to improve the understanding of PAVMs and avoid misdiagnosis and missed diagnosis.

Prognostic value of transthoracic lung ultrasound comet-tail and extravascular lung water index in septic patients / 中华危重病急救医学

Objective:To evaluate the prognostic value of transthoracic lung ultrasound comet-tail and extravascular lung water index (EVLWI) in septic patients.Methods:A prospective cohort study was conducted. Sixty septic patients admitted to department of intensive care unit (ICU) of Sichuan Provincial People's Hospital from November 2016 to October 2019 were enrolled. The EVLWI and pulmonary vascular permeability index (PVPI) were determined by pulse-indicated continuous cardiac output (PiCCO) system at 0, 24, 48 and 72 hours. At the same time, the numbers of comet tail signs in both lungs (parasternal, midclavicular, axillary to midaxillary) were collected by chest ultrasound. Moreover, arterial blood gas analysis, such as pH value, central venous-to-arterial carbon dioxide difference (Pcv-aCO 2), central venous oxygen saturation (ScvO 2), blood lactic acid (Lac), PaO 2/FiO 2 were measured. Pearson correlation analysis was performed between the number of comet-tail sign and EVLWI. Multivariate Logistic regression model was used to analyze the relationship between the number of comet-tail sign, EVLWI and prognosis. Receiver operator characteristic curve (ROC curve) was drawn to predict the prognosis. Results:There were 43 males and 17 females in 60 septic patients. The average age was (64.3±15.5) years old (range: 31-83 years old). There were 35 cases with pulmonary infection, 10 cases with abdominal infection, 6 cases with urinary tract infection, 3 cases with skin and soft tissue infection, 3 cases with intestinal infection, 1 case with meningitis, 1 case with cellulitis and 1 case with multiple injury. Acute respiratory distress syndrome (ARDS) occurred with 8 patients; 40 patients (66.7%) survived and 20 patients (33.3%) died on day 28. Pearson correlation analysis showed that the number of comet-tail sign was positively correlated with EVLWI ( r = 0.944, P < 0.001). There was significant difference in the number of comet-tail signs among sepsis patients with different primary infection sites ( H = 17.714, P < 0.001). The number of comet-tail signs in sepsis patients with pulmonary infection [19 (13, 27)] was significantly higher than that with other infections. The number of comet-tail sign in patients with ARDS was significantly higher than that in patients without ARDS [27 (19, 30) vs. 15 (9, 24), H = 25.387, P < 0.001]. Multivariate Logistic regression analysis showed that EVLWI, the number of comet-tail signs and PVPI were independent risk factors for death in septic patients [odds ratio ( OR) and 95% confidence interval (95% CI) were 10.772 (1.161-99.851), 2.360 (1.070-5.202), 2.042 (1.152-3.622), all P < 0.05]. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value of Logistic regression model based on comet-tail sign and EVLWI were 90.0%, 90.0%, 90.0%, 81.8%, 94.7%, respectively, and area under curve (AUC) were 0.926±0.018, 95% CI was 0.912-0.975, P < 0.001. Conclusions:The transthoracic lung ultrasound comet-tail in septic patients is significantly correlated with EVLWI monitored by PiCCO. The transthoracic lung ultrasound comet-tail combined with EVLWI can better improve the sensitivity, specificity and accuracy of 28-day prognosis in septic patients.

The predictive value of red blood cell distribution width in predicting the prognosis of patients with Extracorporeal Membrane Oxygenation / 中华急诊医学杂志

Objective:To explore the predictive value of Red Blood Cell Distribution Width (RDW) in predicting the prognosis of patients with Extracorporeal Membrane Oxygenation (ECMO).Methods:The clinical data of patients undergoing ECMO admitted to Intensive Care Unit of Sichuan Provincial People’s Hospital from January 2015 to January 2020 were retrospectively analyzed. Patients were divided into the survival group and death group according to the prognosis during ICU hospitalization. The patients' basic data , acute physiology and chronic health score system Ⅱ (APACHE Ⅱ), RDW and activated partial thromboplastin time (APTT) at 72 hours after treatment with ECMO were compared between the two groups. Univariate and Logistic regression multivariate analyses were used to analyze the prognostic factors of patients with ECMO, predictive models and death warning scores were established. The receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficacy of RDW and death warning scores for the prognosis of patients with ECMO.Results:A total of 71 patients with ECMO who met the inclusion criteria were included, including 38 patients in the death group and 33 patients in the survival group. The age, APACHE-Ⅱscore, 72 h RDW and 72 h APTT in the death group were higher than those in the survival group. Respectively, the hospitalization time of ICU in the death group was significantly lower than that in the survival group ( P< 0.05). Logistic regression analysis showed that APACHE-Ⅱscore ( OR=1.117, P=0.047)、72 h RDW( OR=1.102, P=0.029) and 72 h APTT ( OR=1.049, P=0.029) were independent risk factors for death in patients with ECMO. ROC curve analysis showed that the area under ROC curve (AUC) of the APACHE-Ⅱ, score 、72 h RDW and 72 h APTT were 0.691, 0.691 and 0.632( P<0.05), Respectively, the combined AUC was 0.764, the sensitivity was 0.526, and the specificity was 0.909. The death warning score of patients with ECMO was established according to the Predictive model , which is less than 2 points with low risk of death and more than 2 points with high risk of death. The area under the ROC curve of death warning score is 0.8, the sensitivity is 0.607 and the specificity is 0.923. Conclusions:The RDW at 72 hours after treatment with ECMO has a good value in predicting the prognosis of patients with ECMO. Besides, a greater predictive value for the prognosis of patients with ECMO by combining 72 hours RDW, 72 hours APTT with APACHE-Ⅱscore than that of any separate indicator.

Validation of the Chinese version of ureteral stent symptom questionnaire / 中华全科医师杂志

Objectives:To validate the Chinese version of the Ureteral Stent Symptoms Questionnaire(Chinese-USSQ) in patients with an indwelling ureteral stent.Methods:The original USSQ was translated into Chinese and linguistically validated following the cross-cultural adaptation of health-related quality of life measures.A total of 83 patients (cases) with indwelling ureteral stent and 90 healthy subjects (controls) were asked to complete the Chinese-USSQ as well as European Quality of Life Visual Analogue scale(EQ-VAS)(for both genders), the International Prostate Symptom Scale (IPSS) (for male), and Urogenital Distress Inventory-6 (for female). Patients were evaluated at weeks 1 and 4 after stent placement and at week 4 after removal. The psychometric properties of the questionnaire were analyzed.Results:The Chinese version of USSQ include 43 items, which addressed various domains of health(6 sections) covering urinary symptoms, pain, general health, work performance and sexual matters with additional problems. A total of 78 patients(45 males and 33 females) and 90 controls (41 males and 49 females)were included for analysis. Internal consistencies (Cronbach′s α coefficients: 0.60-0.78) and test-retest reliability (Spearman correlation coefficient: 0.69-0.91) were satisfactory for urinary symptom, body pain, general health, and work performance domains. Most USSQ domains showed moderate correlations with each other. The convergent validity determined by correlation between other instruments and corresponding USSQ domain was satisfactory. At week 4 it was moderate for the urinary symptoms index compared to the IPSS in men(Spearman correlation coefficient>0.60), for the urinalry symptoms index compared to the UDI-6 score in women(Spearman correlation coefficient 0.52).Sensitivity to change and discriminant validity were also good in most domains ( P<0.01). Only a small proportion of the study population had an active sexual life with the stent in situ, which limited its analysis. Only 1(1.3%) and 6(7.7%) patients had an active sex life at week 1 and 4 after stent placement; meanwhile, 34(43.6%) patents were sexually active at week 4 after stent removal. Conclusion:The Chinese version of the USSQ is a reliable and valid instrument that can be used for Chinese patients with a indwelling ureteral stent in the clinical and research settings.

Upper urinary tract calculi complicating with emphysematous pyelonephritis: 5 cases report and literature review / 中华泌尿外科杂志

Objective:To discuss the clinical manifestation, diagnosis and treatment of upper urinary tract calculi complicating with emphysematous pyelonephritis(EPN).Methods:The clinical data of 5 cases of upper urinary tract calculi complicating with EPN diagnosed in our department from July 2012 to December 2019 were retrospectively analyzed, and literatures were reviewed. 5 patients were identified by computed tomography scanning to upper urinary tract calculi complicating with EPN, 3 female and 2 male, aged 40-67 years, 2 staghorn calculi and 3 multiple stones. One patient suffered from diabetes mellitus. All cases presented with fever at the enrollment point, and the body temperature were 38.7℃, 38.8℃, 37.5℃, 38.6℃, 40.0℃, respectively. And the number of white blood cells and neutrophile granulocyte of these cases were higher than normal reference value, were 17.2×10 9/L, 0.90; 14.9×10 9/L, 0.89; 11.2×10 9/L, 0.85; 15.1×10 9/L, 0.87; 13.3×10 9/L, 0.88, respectively. The C-reactive protein were increased in all of the cases, especially in case 1(68 mg/l), case 2(253 mg/l), and case 5(67 mg/l). And 3 cases with renal insufficiency. Case 3 and case 4 were controlled the infection with medical management alone, and case 5 with percutaneous drainage plus medical management. The pyelonephritis of other 2 cases were uncontrolled, the body temperature of case 1 returned to normal after treated with percutaneous drainage of perirenal abscess plus nephrostomy plus medical management, but the imaging findings of kidney was not relief by CT scan after 4 weeks. Case 2 was persistent fever until treated with fluconazole according to the medicine sensitive experiment’s result of urine culture after undergoing nephrostomy plus indwelled a double J tube in ureter, but the CT findings of kidney grew worse 1 week later. Results:Of the 5 patients, 1 received first-stage nephrostomy and second-stage percutaneous nephrolithotomy, 2 received same session surgery, 2 received nephrectomy. There was no complications occurred except postoperative fever in 1 case. Postoperative pathology of the nephrectomy revealed glomerular sclerosis, glomerulus dilation, and inflammatory granulation tissue was formed. And 1-84 months follow-up showed no recurrence in all the cases.Conclusions:Upper urinary tract calculi complicating with EPN is an rare acute severe infection, CT is the best choice of early diagnosis, double J stenting or percutaneous drainage of abscess with broad-spectrum antibiotics could be the preferred treatment.

Clinical characteristics of liver damage in 30 patients with severe coronavirus disease 2019 in Sichuan area / 中华危重病急救医学

Objective:To describe the characteristics of liver damage in severe coronavirus disease 2019 (COVID-19) patients in Sichuan area and the effect of antiviral drugs on liver function.Methods:The clinical data of severe COVID-19 patients admitted to Chengdu Public Health Clinical Medical Center from January 21 to February 24, 2020 were retrospectively collected, including demographic data, clinical manifestations and liver function changes within 1 week after admission to intensive care unit (ICU). The changes of liver function during the course of disease in severe COVID-19 patients were analyzed and summarized, and group analysis was performed.Results:A total of 30 COVID-19 patients with complete clinical data were enrolled. The incidence of severe COVID-19 in elderly men was higher (60.0%), with median age of 61 (47, 79) years old, and those aged 80 or above accounted for 23.3%. The severe COVID-19 patients mainly presented with respiratory symptoms such as fever (96.7%), cough (80.0%) and dyspnea (66.7%). The alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and prothrombin time (PT) of 30 patients were increased to various degrees within 1 week after ICU admission, and albumin (ALB) was decreased. ① The patients were divided into two groups according to whether to take lopinavir/ritonavir (kaletra). It was shown that the incidence of liver dysfunction in patients taking kaletra was significantly higher than those who did not take kaletra (7-day abnormal rate of ALT was 54% vs. 33%, the abnormal rate of AST was 38% vs. 33%, the abnormal rate of TBil was 8% vs. 0%), but there were no statistical differences (all P > 0.05). ② The patients were divided into normal dose group (500 mg, twice a day, n = 19) and reduced dose group (250 mg, twice a day, n = 5) according to the dosage of kaletra. It was shown that patients taking low-dose kaletra had a smaller effect on liver function within 1 week after ICU admission than those receiving normal dosage, and ALB, TBil in the reduced dose group were significantly lower than those in the normal dose group on the 2nd day after ICU admission [ALB (g/L): 33.3±2.0 vs. 37.5±4.0, TBil (μmol/L): 6.3±3.3 vs. 11.3±4.8, both P < 0.05]. Conclusions:Severe COVID-19 patients in Sichuan area suffered obvious liver damage in the early course of the disease and have a slower recovery. It is important to pay attention to avoid using drugs that can aggravate liver damage while treating the disease. If there is no alternative drug, liver protection treatment should be considered appropriately.

Preliminary study of accurate position fixation between polyurethane styrofoam and vacuum negative pressure pad in IMRT after radical mastectomy for breast cancer / 中华放射肿瘤学杂志

Objective@#To preliminarily investigate the difference of position fixation accuracy between polyurethane styrofoam and vacuum negative pressure pad in intensity-modulated radiation therapy (IMRT) after radical mastectomy for breast cancer.@*Methods@#Forty breast cancer patients, who received breast-conserving surgery followed by hyper-fractionated IMRT of the whole breast (42.56 Gy for 16 times) in our hospital between 2017 and 2018 were recruited and randomly divided into the polyurethane styrofoam group and vacuum negative pressure pad group. Before IMRT treatment, the anterior and lateral films of patients were taken with kilovoltage digital radiographs (KVDRs) by Varian Trilogy machine-borne OBI KV image verification system. The KVDRs images were matched with the DRR images reconstructed by the planned system to obtain the setup errors in the left and right, head and foot, and ventral and back directions between two groups. Each patient was verified for 10 times to obtain 400 sets of data. The independent sample t-test was adopted to analyze the setup errors between two groups. The external expansion value of graded setup errors from clinical target volume (CTV) and planned target volume (PTV) was calculated.@*Results@#The setup errors in the left and right, head and foot, ventral and back directions between the styrofoam fixation and vacuum pad groups were (1.63±1.29) mm and (1.83 ±1.61) mm (P=0.18), (1.46±1.51) mm and (2.26±2.03) mm (P=0.00), and (1.30±1.35) mm and (1.91±1.67) mm (P=0.00), respectively. The external expansion values of setup errors from CTV to PTV were 2.19 mm, 2.51 mm, 1.57 mm and 2.40 mm, 3.97 mm and 2.63 mm, respectively.@*Conclusion@#Both two fixation methods meet the clinical requirements. However, the setup accuracy and reproducibility in the polyurethane styrofoam group are better than those in the vacuum negative pressure pad group.

Preliminary study of accurate position fixation between polyurethane styrofoam and vacuum negative pressure pad in IMRT after radical mastectomy for breast cancer / 中华放射肿瘤学杂志

Objective To preliminarily investigate the difference of position fixation accuracy between polyurethane styrofoam and vacuum negative pressure pad in intensity-modulated radiation therapy (IMRT) after radical mastectomy for breast cancer.Methods Forty breast cancer patients,who received breast-conserving surgery followed by hyper-fractionated IMRT of the whole breast (42.56 Gy for 16 times) in our hospital between 2017 and 2018 were recruited and randomly divided into the polyurethane styrofoam group and vacuum negative pressure pad group.Before IMRT treatment,the anterior and lateral films of patients were taken with kilovoltage digital radiographs (KVDRs) by Varian Trilogy machine-borne OBI KV image verification system.The KVDRs images were matched with the DRR images reconstructed by the planned system to obtain the setup errors in the left and right,head and foot,and ventral and back directions between two groups.Each patient was verified for 10 times to obtain 400 sets of data.The independent sample t-test was adopted to analyze the setup errors between two groups.The external expansion value of graded setup errors from clinical target volume (CTV) and planned target volume (PTV) was calculated.Results The setup errors in the left and right,head and foot,ventral and back directions between the styrofoam fixation and vacuum pad groups were (1.63± 1.29) mm and (1.83 ± 1.61) mm (P=0.18),(1.46t1.51) mm and (2.26±2.03) mm (P=0.00),and (1.30±1.35) mm and (1.91±1.67) mm (P=0.00),respectively.The external expansion values of setup errors from CTV to PTV were 2.19 mm,2.51 mm,1.57 mm and 2.40 mm,3.97 mm and 2.63 mm,respectively.Conclusion Both two fixation methods meet the clinical requirements.However,the setup accuracy and reproducibility in the polyurethane styrofoam group are better than those in the vacuum negative pressure pad group.

Comparison of imbolization accuracy between styrofoam and breast carrier in intensity-modulated radiotherapy after breast conservative surgery for breast cancer patients / 中华放射肿瘤学杂志

Objective To investigate the difference of styrofoam and breast carrier in postposition fixation of intensity-modulated radiotherapy after breast conservative surgery for breast cancer patients.Methods From February 2018 to August 2018,tweenty-four patients with breast cancer in Sun Yet-Sen Memorial Hospital of Sun Yet-sen University were selected for this study,who underwent hypofactionationed radiotherapy after breast conservative surgery with total dose 42.56 Gy/16Fractions.They were randomized into styrofoam test group and breastcarrier control group.Cone beam CT as used to record the positioning error under the directions of left and right (x),head and foot (y),abdomen and back (y) within two groups at the first,third,fifth,seventh,eleventh time before irradiation.Furthermore,the PTV extension margin was calculated and the positioning time of two groups was recorded.Two sets of pendulum errors were analyzed by independent sample T-test,and the outspread value of inter-fractional set up error of the PTV was calculated.Results The errors of the test group and the control group in the direction of x,y,z were as follows:(2.36±1.89) and (2.56±2.05) mm (P=0.49),(1.76± 1.78) and (3.28±2.79) mm (P＜0.05),(1.47± 1.49) and (1.73± 1.81) mm (P=0.28).The extension values of inter-fractional set up error of CTV to PTV were 2.97,2.92,2.21 mm and 3.41,4.09,2.59 mm respectively.The time of single positioning was (3.4± 1.1) and (5.5 ± 3.1) min respectively (P=0.01).Conclusion Styrofoam has better positioning accuracy and efficiency compared with breast carrier.

Delay in initiating postmastectomy radiotherapy is associated with inferiorsurvival outcomes for locally advanced breast cancer patients treated with neoadjuvant chemotherapy and mastectomy / 中华放射肿瘤学杂志

Objective To evaluate the effect of surgery-radiotherapy interval (SRI) on clinical prognosis of locally advanced stage c Ⅱ-Ⅲ breast cancer patients treated with neoadjuvant chemtherapy and modified radical mastectomy.Methods Clinical data of 1 087 breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy from 11 hospitals in China were retrospectively analyzed.The optimal threshold value of SRI upon clinical prognosis was determined by maxstat method.The effect of SRI on clinical prognosis was evaluated by using multivariate Cox regression analysis and propensity score matching (PSM).Results The median follow-up time was 72.9 months.The 5-year disease-free survival (DFS) and overall survival (OS) rates were 68.1％ and 81.8％.All patients were divided into SRI ≤18 weeks (n=917) and SRI＞ 18 weeks groups (n=170).Multivariate Cox regression analysis demonstrated that hormone receptor status (P＜0.001),pathological T stage (P＜0.001),pathological N stage (P＜0.001) and SRI (P=0.023) were independent influencing factors of DFS.Hormone receptor status (P=0.013),pathological T stage (P=0.006),pathological N stage (P＜0.001),endocrine therapy (P=0.013) and SRI (P=0.001) were significantly associated with OS.After balancing the clinical and pathological factors with PSM,patients with SRI＜ 18 weeks had superior DFS and OS to those with SRI＞ 18 weeks.Conclusions SRI affects the clinical prognosis of locally advanced breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy.Radiotherapy should be performed within 18 weeks after mastectomy.

Prognostic value of Charlson weighted index of comorbidities combined with sequential organ failure assessment score and procalcitonin in patients with sepsis / 中华危重病急救医学

Objective@#To assess the prognostic value of Charlson weighted index of comorbidities (WIC) combined with sequential organ failure assessment (SOFA) score and procalcitonin (PCT) in sepsis patients in intensive care unit (ICU).@*Methods@#A prospective cohort study was conducted. 118 patients with sepsis admitted to ICU of Sichuan Provincial People's Hospital from July 2015 to June 2018 were enrolled. The clinical data of the patients including gender, age, pathogenic factors, site of infection, underlying diseases and 28-day prognosis were collected, while the WIC score at ICU admission, the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and SOFA score within 24 hours after ICU admission, serum PCT level within 1 hour after ICU admission were recorded. The patients were divided into survival group and death group according to 28-day prognosis, and the clinical data of patients with different prognosis were compared. Multivariate Logistic regression model was used to analyze the relationship between WIC score, SOFA score, PCT level and the outcomes of patients. The receiver operating characteristic (ROC) curve was drawn to evaluate the value of WIC score, SOFA score, and PCT level for predicting the prognosis of patients with sepsis.@*Results@#In this study, 118 eligible sepsis patients were enrolled, and 94 patients survived at 28 days, and 24 patients died with a 28-day mortality of 20.3%. Compared with the survival group, the patients in the death group were older and had higher APACHEⅡ score, WIC score, SOFA score, and serum PCT levels. Pathogenic factors analysis showed that the proportion of pulmonary infection in the death group was the highest (62.5%), while in the survival group the main cause was multiple injury (36.2%), followed by pulmonary infection (30.9%). Basic diseases analysis showed that the proportions of tumor, type 2 diabetes, chronic lung disease, cerebrovascular disease, chronic kidney disease, chronic liver disease, and chronic cardiac insufficiency in the death group were significantly higher than those in the survival group. The age [odds ratio (OR) = 1.279, 95% confidence interval (95%CI) was 1.065-1.536], APACHEⅡ score (OR = 1.255, 95%CI was 1.083-1.455), WIC score (OR = 1.429, 95%CI was 1.304-1.568), SOFA score (OR = 1.331, 95%CI was 1.456-1.545), and serum PCT level (OR = 1.497, 95%CI was 1.146-1.547) were related to the 28-day prognosis of patients with sepsis, and were independent predictors of 28-day prognosis in patients with sepsis (all P < 0.01). ROC curve analysis showed that the area under ROC curve (AUC) of WIC score, SOFA score, serum PCT level and combined prediction probability was 0.712 (95%CI was 0.588-0.836), 0.801 (95%CI was 0.695-0.908), 0.889 (95%CI was 0.798-0.979), 0.943 (95%CI was 0.884-1.000), respectively, indicating that the accuracy of combined parameters to predict survival outcome was higher than that of any single parameter with the sensitivity of 91.7% and the specificity of 83.0%.@*Conclusion@#WIC score, SOFA score combined with serum PCT level can improve the accuracy of predicting the 28-day prognosis in patients with sepsis.

Prognostic value of Charlson weighted index of comorbidities combined with sequential organ failure assessment score and procalcitonin in patients with sepsis / 中华危重病急救医学

To assess the prognostic value of Charlson weighted index of comorbidities (WIC) combined with sequential organ failure assessment (SOFA) score and procalcitonin (PCT) in sepsis patients in intensive care unit (ICU). Methods A prospective cohort study was conducted. 118 patients with sepsis admitted to ICU of Sichuan Provincial People's Hospital from July 2015 to June 2018 were enrolled. The clinical data of the patients including gender, age, pathogenic factors, site of infection, underlying diseases and 28-day prognosis were collected, while the WIC score at ICU admission, the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and SOFA score within 24 hours after ICU admission, serum PCT level within 1 hour after ICU admission were recorded. The patients were divided into survival group and death group according to 28-day prognosis, and the clinical data of patients with different prognosis were compared. Multivariate Logistic regression model was used to analyze the relationship between WIC score, SOFA score, PCT level and the outcomes of patients. The receiver operating characteristic (ROC) curve was drawn to evaluate the value of WIC score, SOFA score, and PCT level for predicting the prognosis of patients with sepsis. Results In this study, 118 eligible sepsis patients were enrolled, and 94 patients survived at 28 days, and 24 patients died with a 28-day mortality of 20.3%. Compared with the survival group, the patients in the death group were older and had higher APACHEⅡ score, WIC score, SOFA score, and serum PCT levels. Pathogenic factors analysis showed that the proportion of pulmonary infection in the death group was the highest (62.5%), while in the survival group the main cause was multiple injury (36.2%), followed by pulmonary infection (30.9%). Basic diseases analysis showed that the proportions of tumor, type 2 diabetes, chronic lung disease, cerebrovascular disease, chronic kidney disease, chronic liver disease, and chronic cardiac insufficiency in the death group were significantly higher than those in the survival group. The age [odds ratio (OR) = 1.279, 95% confidence interval (95%CI) was 1.065-1.536], APACHEⅡ score (OR = 1.255, 95%CI was 1.083-1.455), WIC score (OR = 1.429, 95%CI was 1.304-1.568), SOFA score (OR = 1.331, 95%CI was 1.456-1.545), and serum PCT level (OR = 1.497, 95%CI was 1.146-1.547) were related to the 28-day prognosis of patients with sepsis, and were independent predictors of 28-day prognosis in patients with sepsis (all P < 0.01). ROC curve analysis showed that the area under ROC curve (AUC) of WIC score, SOFA score, serum PCT level and combined prediction probability was 0.712 (95%CI was 0.588-0.836), 0.801 (95%CI was 0.695-0.908), 0.889 (95%CI was 0.798-0.979), 0.943 (95%CI was 0.884-1.000), respectively, indicating that the accuracy of combined parameters to predict survival outcome was higher than that of any single parameter with the sensitivity of 91.7% and the specificity of 83.0%. Conclusion WIC score, SOFA score combined with serum PCT level can improve the accuracy of predicting the 28-day prognosis in patients with sepsis.

Treatment of underactive bladder with clean intermittent self-catheterization / 中华泌尿外科杂志

Objective To evaluate the clinical outcome and the problems of patients who have performed the clean intermittent self-catheterization(CISC)through detailed telephone interviews and then develop corresponding measures to solve.Methods In this study,telephone interviews were carried out in 27 patients who were diagnosed as detrusor underactivity from January 2011 to September 2015,and received CISC as treatment.They were asked to finish the micturition diary and answer questions from 4 questionnaires of which the first one was IPSS and the other 3 parts were ICDQ,InCaSaQ,and SF-36. Results 27 patients completed the follow-up interview,and the median time of CISC is 1 8 months.The average frequency of voiding by catheterization was 3.7 times a day.After the intervention of CISC,the symptoms of voiding difficulty and chronic urinary retention in all the 27 patients were relieved.11.1% of the 27 patients experienced urinary tract infection.The average ICDQ score was 0.4 and 88.9% of them were satisfied with the current states and what they experienced after performing CISC.The average InCaSaQ score was 2.15.The average physical and mental score from SF-36 questionnaire was 76.9 and 79.2 respectively.Conclusions CISC is an easy-to-do operation that relieves retention effectively and protects upper urinary tract function.The incidence of complications is quite low and the influence on quality of life is moderate,making it easy to persist in the long term of bladder management.

Clinical effect of medical radiation protective ointment compared with trolamine cream to prevent acute radiation-induced skin injury in breast cancer patients undergoing radiotherapy after modified radical mastectomy / 中华放射肿瘤学杂志

Objective To access the clinical effect of medical radiation protective ointment compared with trolamine cream to prevent acute radiation-induced skin injury in breast cancer patients undergoing radiotherapy after modified radical mastectomy. Methods Between February 2017 and February 2018,a total of 120 stage T1-4 N1-3 M0 eligible patients received intensity modulated radiation therapy were enrolled and matches into two groups:study group (60 cases) was administered medical radiation protective ointment from the first irradiation fraction,and control group (60 cases) received trolamine cream. When 3 grade reaction was observed,patients in control group start to administer medical radiation protective ointment until a month after radiation. Results The occurrence rate of acute breast dermal radiation reaction was 100％.Most patients in study group only underwent 1 grade radiation reaction (82％),while 2 and 3 grade radiation reaction (47％ and 13％) in control group were common ( P= 0. 000). Both pruritic degree and pain degree were higher in control group compared with study group (both P= 0. 000).In study group,the occurrence of 2 grade acute radiation-induced skin injury was obviously later than in control group with significant difference (P= 0. 000).Patients observed with 3 grade reaction relieved to certain reaction after administering medical radiation protective ointment. Conclusions Medical radiation protective ointment can effectively both alleviate and delay acute radiation-induced skin injury compared with trolamine cream. It also has therapeutic effect on 3 grade radiation reaction.

Serological and molecular epidemiology of Japanese encephalitis virus infections in swine herds in China, 2006–2012

Japanese encephalitis virus (JEV) is a mosquito-borne, zoonotic flavivirus causing viral encephalitis in humans and reproductive disorder in swine. JEV is prevalent throughout China in human; however, spatiotemporal analysis of JEV in Chinese swine herds has not been reported previously. Herein, we present serological and molecular epidemiological results and estimates of prevalence of JEV infections among swine herds in various regions of China. The results suggest that JEV infections are widespread and genotype I and III strains co-exist in the same regions. Therefore, there is an urgent need to monitor JEV infection status among swine herds in China.

The analysis of urolithiasis incidence in the contralateral kidney of unilateral nephrectomy patients / 中华泌尿外科杂志

Objective To analyze the incidence of urinary stone formation in the contralateral kidney of unilateral nephrectomy patients.Methods 1048 patients,including 596 males and 452 females,underwent unilateral nephrectomy from June 2010 to June 2016.Their age ranged from 16-87 years old (mean 58.7 years old).532 patients combined with components of metabolic syndrome and 213 patients with metabolic syndrome.164 patients had a previous history of urolithiasis.The incidence of urinary stone formation in the contralateral kidney after nephrectomy was recorded and analyzed.The urolithiasis incidences in different gender,age,comorbidity and history of urolithiasis patients after uninephrectomy were compared.Results All patients were followed up within 0.5 to 6 years (mean 3.2 years).89 patients suffered from urinary stones in the contralateral kidney after uninephrectomy.The incidence of urinary stone formation in the contralateral kidney was 8.5％ (89/1048),which was higher than that in general population of China.1％-5％.The urolithiasis incidence was 9.1％ (54/596)in male patients and 7.7％ (35/452)in female patients after nephrectomy.The incidence of urinary stone formation was 8.6％ (3/35)in patients aged under 30 years old,12.5％ (34/272) in patients aged 30-49 years old,7.3％ (37/504) in patients aged 50-69 years old,6.3％ (15/237)in patients aged 70 and over.The incidence of urinary stone formation was 12.2％ (65/532) in patients with components of metabolic syndrome after nephrectomy and 19.7％ (42/213) in patients with metabolic syndrome,while the incidence was 4.7％ (24/516)in patients without components of metabolic syndrome.In patients with history of urolithiasis,the incidence was up to 30.5％ (50/164) after nephrectomy,while 4.4％ (39/884)in patients without history of urolithiasis.Conclusions The incidence of urinary stone formation in the contralateral kidney of uninephrectomy patients was higher,especially in patients with metabolic syndrome or urolithiasis history.Patients after unilateral nephrectomy are more vulnerable to urolithiasis.

Effect of Early Respiratory Exerciser Training on Respiratory Function of Patients with Hypoxemia after Coronary Artery Bypass Grafting / 中国康复理论与实践

@#Objective To observe the efficacy of early pulmonary rehabilitation training on respiratory function of patients with hypox-emia after coronary artery bypass grafting. Methods From February, 2013 to September, 2016, 53 patients with hypoxemia after coronary ar-tery bypass grafting were randomly divided into control group (n=25) and observation group (n=28). Both of them received routine therapy, while the observation group received pulmonary rehabilitation training in addition. Results Three days after extubation, the forced expirato-ry volume in one second (FEV1) (measured) and FEV1/forced vital capacity (FVC) were higher in the observation group than in the control group (t>3.590, P<0.01), while the level of PaO2 was higher (t=5.824, P<0.001); the FEV1 (measured), FEV1(measured/ predicted) and FEV1/FVC decreased in both groups (F>1.044, P<0.05). The hospital stay was shorter (t=―2.138, P=0.037). The level of PaO2 was the high-est one day after extubation among three time points in both groups (P<0.001). No significantly difference was observed in mechanical ven-tilation time and ICU stay between two groups (P>0.05). Conclusion Early respiratory exerciser training could improve the respiratory func-tion of patients with hypoxemia after coronary artery bypass grafting, shorten hospital stay.

Malignant tumors after renal transplantation clinical analysis of malignant tumors after renal transplantation / 中华泌尿外科杂志

Objective To analyze and summarize the risk factors and treatment options of post-renal transplantation. Methods We reviewed 445 renal transplant cases from May 1991 to October 2016 from our hospital. And we had 24 patient received renal transplantation elsewhere who developed malignant tumor afterwards. Among them, 14 patients were male, and 10 patients were female. The age ranged from 42 to 61 years old, with an average age of 54.5 years. 22 patients underwent hemodialysis, with an average of 14.6 months; 2 patients underwent peritoneal dialysis, and the duration is 15 months. 19 patients underwent the transplant for the first time, and 5 patients underwent second transplant. 13 of them developed tumors, and the incidence is 2.9%. In the 24 tumor patients: 19 were urothelial cancer, accounting for 79% (9 renal pelvis and ureter cancer, 8 primary ureter urothelial cancer and 2 primary bladder urothelial cancer), transplant kidney cancer 1 case, thyroid cancer 1 case, colon cancer 1 case and lymphoma 1 case. We analyzed the incidence rate of tumor, type of tumor, time to malignant tumor after surgery, time to diagnosis of tumor after surgery, usage of immune-suppressive medications and prognosis to stratify risk factors of malignant tumor development.Results Only 1 patient with lymphoma underwent chemotherapy, other 23 patients underwent radical operations. All the patients underwent eradicative surgery of malignant tumor, except one patient with lymphoma underwent chemotherapy. Among the 21 patients with urinary system cancers: 2 patients underwent open surgeries (1 patient underwent semi-urinary system resection, 1 patient underwent transplant kidney partial resection), 2 patient underwent TURBT, 17 patients underwent laparoscopic renal pelvis and ureter kidney resection. 3 patients underwent secondary TURBT in one year, 2 patients underwent 3 operations due to recurrent. 18 of them remain healthy; 5 patients had tumor recurrence after the surgery and are deceased 3 years later.Conclusions Post-transplantation patients are susceptible to malignant tumor development, which is closely related to the use of immune suppressant after transplantation. The key to optimal treatment is to detect tumor at an early stage.