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Objective:The aim of the study is to investigate the inter-observer and intra-observer precision in manually segmentation of organs-at-risk(OARs) for cervical cancer on the basis of MR image, and to preliminarily explore sequence selection designed for radiotherapy planning.Methods:Thirty cervical cancer patients scanned by MR-sim from 2016 to 2018 in the department of radiotherapy of Sun Yat-sen university cancer center were retrospectively analyzed. T1WI, T1dixonc and T2WI sequence from MR-simulator were selected and imported into Monaco planning system. Manual segmentation of 5 organs-at-risk (bladder, rectum, anal canal, and left/ right femoral head) was done by 2 independent experienced physicians on three sequences acquired from these patients. A month later, the second segmentation of the OARs in the T1WI sequence was done by one of the two physicians. Dice similarity coefficient (DSC), Hausdorff distance (HD) and position difference(Δ x, Δ y, Δ z) of each OAR were used to analyze the robustness of inter-observer and intra-observer segmentation OARs. Results:The HD values of five OARs segmentation by the two physicians in T1WI, T1dixonc and T2WI sequences and the same physician in T1WI at different time were all less than 2 mm; the position differences were less than 5 mm. The DSC values, HD values and difference position values of the two physician and the same physician at different time was positively correlated with the volume of OARs ( R=0.178-0.582, P<0.05). Due to the small volume of the anal canal (7.385±1.555) cm 3, the DSC values were less than 0.7 and the performance was slightly worse. The average DSC values of other OARs were all greater than 0.82. Comparing the DSC, HD and position differences of OARs in the three sequences, DSC values of rectum, left / right femoral head and bladder, HD values of left/right femoral head and rectum, and Δ z axis difference of anal canal and right femoral head of T1WI sequence were better than T1dixonc ( t=-3.116-3.604, P<0.05); DSC value of rectum and HD value of anal canal in T1WI sequence were better than T2WI sequence( t= 2.934, 3.677, P<0.05 ); T1dixonc sequence rectal DSC, right femoral head Δ z axis difference were slightly better than T2WI( t=6.806, 2.130, P<0.05 ). T2WI sequence bone tissue (left/right femoral head) stability was better than T1WI, T1dixonc, and the difference was statistically significant ( t=-6.580-6.542, P<0.05). Conclusions:From three index of DSC, HD and position difference, the robustness of inter-observer and intra-observer segmentation of bladder, rectum and femoral head are fine based on MR sequence, followed by anal canal. In addition, the robustness of OARs segmentation by T1WI sequence is better than that of T1dixonc and T2WI sequence.
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Objective To investigate the clinical treatment and outcomes of severe community-acquired pneumonia (CAP) complicated with mediastinal emphysema after renal transplantation. Methods Clinical data of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation were retrospectively analyzed. The acute physiology and chronic health evaluationⅡ(APACHEⅡ) and oxygenation index were recorded when the patients were admitted to the intensive care unit (ICU). The complications of mediastinal emphysema and corresponding treatment were observed. The treatment course during the ICU, mortality rate in ICU, ICU stay time and hospital stay time were recorded. All patients underwent pathogenic examinations. Results The APACHEⅡ score of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation was 14 (8-21) scores and the oxygenation index was 150 (133-189) mmHg. Among 9 patients, 3 cases were infected by bacteria alone, 3 cases were infected by bacterial infection combined with viral infection, 1 case was infected by mycobacterium tuberculosis complicated with other bacterial infection and 1 case was viral infection. No pathogenic evidence was detected in the remaining 1 patient. Mediastinal emphysema complicated with subcutaneous emphysema occurred in 7 cases and pneumothorax occurred in 6 cases. Treatment methods included anti-infection, modified immunosuppressive program, mediastinal drainage, thoracic closed drainage, subcutaneous incision and extracorporeal membrane oxygenation (ECMO) treatment. Six patients received invasive mechanical ventilation (IMV), 2 received non-invasive positive pressure ventilation (NIV) and 1 received high-flow nasal oxygen cannula (HFNC). Among 9 patients, the mortality rate in ICU was 6/9, the remaining 3 patients were recovered and discharged, the ICU stay time was 26 (17-40) d, and the total hospital stay time was 27-61 d. Conclusions Mediastinal emphysema is a serious complication of patients presenting with severe CAP after renal transplantation with a high mortality rate. For these patients, imaging evaluation, timely drainage and full sedation should be strengthened, and ECMO treatment should be delivered when necessary.
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Objective@#To investigate IMRT planning process using the combined application of failure modes and effects analysis (FMEA) and fault tree analysis (FTA) by reference to the report of Task Group 100 of the AAPM, and stablish and optimize the quality.@*Methods@#A multidisciplinary team detailed the process mapping of IMRT planning using Eclipse TPS. The team evaluated the potential failure modes (FMs) of every process step. The evaluation was divided into two groups according to whether quality management (QM) was considered. For every FM, occurrence (O), severity (S) and detectability (D) by consensus were evaluated, and the product of O, S and D yielded the risk priority number (RPN), which permitted the ranking of the FMs. Finally, FTA was used to determine the root factors contributing to the riskiest failure modes.@*Results@#The IMRT plan process consisted of 10 major sub-processes and 33 steps, which amounted to 47 failure modes. For the group without quality management, the RPN of FMs was between 13.2-271.8, 27 of which had RPN≥80, and 18 FMs had S≥8. For the group with quality management, the RPN of FMs was between 11.2-158.4, 11 of which had RPN≥80. The difference of RPN between the two groups was statistically significant (RPN of the group without QM=101.17±66.34, RPN of the group with QM=59.54±35.64, t=8.501, P<0.05). Finally, FTA was used to determine the root factors contributing to the FMs, i. e., prescription dose definition and importing images.@*Conclusions@#The FMEA and FTA methods are operable and practical, which can systematically and comprehensively analyze the potential failures and risks existing in the process of IMRT plan. And the FMEA and FTA can contribute to establish and optimize the quality management program in radiotherapy.
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Objective To investigate IMRT planning process using the combined application of failure modes and effects analysis ( FMEA) and fault tree analysis ( FTA) by reference to the report of Task Group 100 of the AAPM, and stablish and optimize the quality. Methods A multidisciplinary team detailed the process mapping of IMRT planning using Eclipse TPS. The team evaluated the potential failure modes ( FMs ) of every process step. The evaluation was divided into two groups according to whether quality management ( QM) was considered. For every FM, occurrence ( O) , severity ( S) and detectability ( D) by consensus were evaluated, and the product of O, S and D yielded the risk priority number ( RPN) , which permitted the ranking of the FMs. Finally, FTA was used to determine the root factors contributing to the riskiest failure modes. Results The IMRT plan process consisted of 10 major sub-processes and 33 steps, which amounted to 47 failure modes. For the group without quality management, the RPN of FMs was between 13. 2-271. 8, 27 of which had RPN≥80, and 18 FMs had S≥8. For the group with quality management, the RPN of FMs was between 11. 2-158. 4, 11 of which had RPN≥80. The difference of RPN between the two groups was statistically significant ( RPN of the group without QM=101. 17±66. 34, RPN of the group with QM=59. 54±35. 64, t=8. 501, P<0. 05). Finally, FTA was used to determine the root factors contributing to the FMs, i. e., prescription dose definition and importing images. Conclusions The FMEA and FTA methods are operable and practical, which can systematically and comprehensively analyze the potential failures and risks existing in the process of IMRT plan. And the FMEA and FTA can contribute to establish and optimize the quality management program in radiotherapy.
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Objective To evaluate the prognostic value of blood lactate (Lac) level in sepsis patients with or without diabetes.Methods 106 patients admitted to intensive care unit (ICU) of Zhongshan Hospital Affiliated to Fudan University from April 2015 to November 2016 were enrolled. The patients with age > 18 years and the length of hospital stay > 24 hours were included. Records including blood Lac, serum creatinine (SCr), white blood cell count (WBC), platelet count (PLT), sequential organ failure assessment (SOFA) on the first day of admission; minimum oxygen index (PaO2/FiO2) in 3 days after admission; mechanical ventilation, whether there was a history of diabetes, usage of biguanides, etiology control treatment, usage of continuous renal replacement therapy (CRRT) were collected. According to the level of blood Lac patients were divided into high Lac group (Lac > 2 mmol/L) and low Lac group (Lac ≤ 2 mmol/L);based on their diabetic history, sepsis patients were divided into the diabetes group and non-diabetes group. The survival curve of each group was analyzed by Kaplan-Meier regression analysis, and the factors influencing the prognosis were analyzed by multivariate Cox regression analysis.Results There were 76 males and 30 females sepsis patients, with an average age of (68.1±14.7) years old. In the 51 patients of low Lac group, there were 7 patients who suffered from diabetes. While in the 55 patients of high Lac group, there were 12 patients who suffered from diabetes. Compared with low Lac group, high Lac group had a higher age, higher SOFA score, and a lower proportion of patients who had the treatment of etiology control (allP 0.05). Kaplan-Meier survival curve analysis showed that the 90-day survival rate in the high Lac group was significantly lower than that in the low Lac group (56.36% vs. 90.20%,χ2 = 0.697,P = 0.008). The high Lac group without diabetes had lower survival rate, and the 90-day survival rate was significantly lower than that of the low Lac group without diabetes (58.14% vs. 90.90%,χ2 = 7.152,P = 0.007); there was no significant difference in 90-day survival rate between the high Lac group and the low Lac group with diabetes (50.00% vs. 85.71%,χ2 = 0.012,P = 0.914). Multivariate Cox regression analysis showed that blood Lac was an independent risk factor for the prognosis of sepsis patients [odds ratio (OR) = 3.863, 95% confidence interval (95%CI) = 1.237-12.060,P = 0.020]. After stratification according to their diabetic history, the blood Lac was an independent risk factor for the prognosis of sepsis patients without diabetes (OR = 4.816, 95%CI = 1.407-15.824, P = 0.010), but the blood Lac had no effect on the prognosis of sepsis patients with diabetes (OR = 0.000, 95%CI =0.000-1.103,P = 0.270).Conclusions The predictive value of blood Lac on sepsis patients with or without diabetes was different. The blood Lac was related with the prognosis of sepsis patients without diabetes, while further study should be conducted for the prognostic value of blood Lac in sepsis patients with diabetes, and it's possible to increase the cut-off-point of Lac level in these patients.
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This study was aimed to identify Bletilla Striata (Thunb.) Reichb.f.and Bletilla Formosana (Hayata) Schltr.by ITS2 sequence.The leaves of 38 samples of Bletilla striata and Bletillaformosana from Yunnan,Hubei,Guizhou,Hunan and Sichuan province were used as experiment materials.The total DNA was extracted.Internal transcribed spacer 2 (ITS2) sequences were obtained by PCR.All of the ITS2 sequences were checked.The 8 ITS2 sequences from two species were downloaded from GenBank.The intraspecific and interspecific Kimura-2-parameter (K2P) distances of Bletilla striata and Bletilla formosana were calculated by MEGAS.0.And neighbor-joining (NJ) tree was constructed.The results showed that the full-length sequences of ITS2 from Bletilla striata and Bletillaformosana were 259 bp,with a total of 14 variable sites.The maximum intraspecific K2P distance of Bletilla striata and Bletillaformosana was 0.008,while the minimum interspecific K2P distance was 0.040.The ITS2 secondary structure showed that different origins of Bletilla striata were gathered together and could be distinguished obviously from Bletilla formosana by NJ tree.It was concluded that ITS2 sequence was able to identify Bletilla striata and Bletillaformosana quickly and accurately.
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Objective To investigate the expression of Aire,Foxp3,AchR and other immune factors in human thymoma tissue and plasma and explore their role in myasthenia gravis with thymoma.Methods T lymphocyte subsets,immunoglobulin and other immune factors in plasma were compared,and the Expression of Aire,Foxp3 and AchR were examined in thymoma by reverse transcriptional polymerase chain reaction and immunohistochemical staining,and the results were analyzed by SPSS statistics software.Results The ratio of CD4 + to CD8 + T lymphocyte was much higher in plasma,while the expressions of Aire,Foxp3 and AchR at mRNA and protein level were much lower in thymoma patients with myasthenia gravis,and related to Ossermann subtype,WHO subgroup and Masaoka stage.The differences were statistically significant (P ＜ 0.05).Conclusion The ratio of CD4 + to CD8 + T lymphocyte and the abnormal expressions of Aire and Foxp3could used as an indicator of immune state in thymoma patient with myasthenia gravis and play an important role in the development of thymoma with myasthenia gravis,but the mechanism is indefinite.
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Objective To explore the intellectual profile of children with autism spectrum disorders (ASD) combined with hypophrenia.Methods The study followed a matching design,37 children with ASD combined with hypophrenia and 40 with simply intelligence disability while paired based on gender and age were selected.The intellectual profile of the studied children was determined with the Wechsler intelligence scale for children-Chinese edition (WISC-R) scale.Results The full intelligence quotient (FIQ) of the ASD group and the control group were (54.70±8.26) and (54.60-±7.17),the differences were not statistically significant(P＞0.05).Verbal intelligence quotient(VIQ) and performance intelligence quotient(PIQ) of ASD group were(54.70±8.26) and (64.51±12.25) and the control group were(56.70±8.02) and(57.25±9.43).Children with ASD scored lower on VIQ and higher on PIQ.There was significant difference between the two groups(t=3.582,P＜0.01;t=2.928,P＜0.01).There was statistically significant difference on VIQ-PIQ of ASD group(t=8.14,P＜0.01).The group with ASD had a profile characterized by a high score on Puzzle and Block Design with a low comprehension score.The score of FIQ,VIQ as well as information,arithmetic,comprehension,Picture arrangement were negatively correlated with ABC (r=-0.36,P＜0.05;r=-0.40,P＜ 0.05;r=-0.41,P＜0.05;r=-0.44,P＜0.01;r=-0.44,P＜0.01;r=-0.35,P＜0.05).Conclusion Children with autism spectrum disorders with hypophrenia have special cognitive profile,which can be used to provide basis for making intervention strategies.
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Compared with that for botanical drugs and animal-derived drugs, the identification study for mineral traditional Chi-nese medicines is relatively weak. The traditional identification methods can’ t meet the quality control requirements of mineral tradi-tional Chinese medicines, and the application of modern analysis techniques are needed urgently in the systematic research of mineral traditional Chinese medicines. In the paper, the identification of traditional methods combined with some modern analysis techniques such as X-ray diffraction, near infrared spectroscopy and Raman spectroscopy for mineral traditional Chinese medicines was summarized and analyzed to provide basic idea and methods for the systematic identification construction of mineral traditional Chinese medicines.
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Objective:To explore a new method to identify Sparganium stoloniferum and its adulterants by ITS2 regions. Methods:Eight samples of Sparganium stoloniferum and its adulterants were collected with five species, and 6 species with 23 ITS2 sequence of Sparganium stoloniferum and its adulterants were downloaded from Genbank. The intraspecific and interspecific K2P distances of Spar-ganium stoloniferum and its adulterants were calculated by MEGA5. 0, and the phylogenetic tree was constructed by MEGA 5. 0. Re-sults:The maximum intraspecific K2P distance of Sparganium stoloniferum was 0. 038,while the minimum interspecific K2P distance was 0. 697. The phylogenetic tree showed that Plantago asiatica was different obviously from its adulterants. The different samples of Sparganium stoloniferum were gathered together and could be distinguished from its adulterants by the NJ tree. Conclusion: ITS2 se-quence is able to identify Sparganium stoloniferum and its adulterants correctly, which provides a new method for the identification of Sparganium stoloniferum.
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Objective To investigate the clinical curative effect of ipratropium bromide in combination with ambroxol hydrochloride (mucosolvan) on ventilator-associated pneumonia (VAP) in elderly patients.Methods From Jan 2013 to Nov 2014,a total of 46 elderly patients with VAP in our hospital were treated with ipratropium bromide 0.5 mg diluted in 5 ml saline by inhalation with ventilator,and mucosolvan 30 mg by intravenous injection,3 times/d (treatment group,n=23),and treated with ipratropium bromide 0.5 mg diluted in 5 ml saline by inhalation with ventilator,3 times/d (control group,n=23).Total clinical effective rate,ventilating time,number of sputum suction by fibre bronchoscope and white cell count were compared between the two groups.Results The total clinical effective rate was higher in treatment group than in the control group [91 ％ (21/23) vs.74％(17/23),x2=11.310,P=0.002].The indicators of ventilating time,number of sputum suction by fibre bronchoscope and white cell count were improved in treatment group as compared with control group [(8.2±1.5) d vs.(13.7±3.1) d,(3.5±0.3) vs.(6.7±1.2),(9.5±2.3) × 109/L vs.(14.2±2.7) × 109/L,t=17.510,2.750,3.810,respectively,P=0.000,0.001,0.001].Conclusions Compared with single-drug treatment,ipratropium bromide in combination with ambroxol hydrochloride (mucosolvan) could improve airway humidification,promote cilium to clean secreta,shorten the ventilating time and increase the curative rate of YAP in elderly patients.
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Squamous cell carcinoma is the second most common non -melanoma skin cancer and its morbidity is increasing in recent years .Because of the complicated pathogenesis and non -specific clinical mani-festation of squamous cell carcinoma ,misdiagnosis occurs frequently .Although squamous cell carcinoma usually grows very slowly ,the invasion and metastasis of special types occurs early .With the deep knowledge of squamous cell carcinoma,people get more and more research results in diagnosis ,treatment and prevention .This paper de-scribes the epidemiology ,etiology ,clinical manifestation ,pathology ,clinical staging ,treatment and prognosis .
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Objective:To study the percutaneous permeability of quercetin in Ginkgo Biloba extract in vitro. Methods: Ginkgo Biloba extract was dissolved in 50% ethanol. The percutaneous permeability experiment through mouse skin was conducted using a modified Franz diffusion cell. The penetration amount of quercetin was determined by HPLC. Results:The percutaneous permeability of quercetin in the solution was approximately characterized by zero-order kinetics. Conclusion:Quercetin in Ginkgo Biloba extract can be absorbed through skin.
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Objective: To analyze the influencing factors in thrombin titration for the determination of anticoagulant activity of Whitmania Pigra Whitman. Methods: The white porcelain plates were used as the titration carriers instead of tubes in the titration ( called white porcelain method for short) . The effect of different carriers, interval time of titration and thrombin concentration on the results of anticoagulant activity test was studied. Results:Under the same conditions, the anticoagulant activity was more accurate and stable using white porcelain method. Using white porcelain method with 20 u·ml-1 or 10 u·ml-1 as the thrombin concentration and titrating 5μl each time, once every minute, the thrombin consumption volume was linear with the sample concentration within the range of 0. 125-0. 333 g·ml-1(r20 =0. 961 and r10 =0. 992), and the anticoagulant activity respectively was (33. 08 ± 2. 64) and (31. 24 ±1.32) u·g-1(RSD20 =8.0% and RSD10 =4.2%). As for a certain sample concentration (0.333 g·ml-1), the theoretical error of determination was not more than 10% and 5%. Conclusion:The improved white porcelain method is more suitable for determining anticoagulant activity of Whitmania Pigra Whitman with more stable results and accurate end point states than tube method. Under the conditions of 10 u·ml-1 thrombin concentration, titrating 5μl each time, once every minute, the linearity, accuracy and precision are all promising.
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Objective:To develop a qualitative analysis model for the fast identification of Dens Draconis and its adulterants by NIR correlation coefficient method. Methods:On the basis of the traditional morphological identification, the spectra were collected u-sing the fiber accessory of a near-infrared spectroradiometer. The reference spectra were set up using the NIR spectra of certified Dens Draconis. The characteristic spectral section was chosen and the appropriate threshold was set to establish a qualitative analysis model for the rapid identification of Dens Draconis and its adulterant. Results:The spectral section of 5 000-4 200 cm-1 was selected as the characteristic spectral section, the correlation coefficient of Dens Draconis and its adulterant was calculated in training set samples, and 92. 67% was used as the threshold. Totally 10 batches of validation set samples were validated the qualitative analysis model, and the prediction accuracy was 90%. Conclusion:The method has good prediction ability, and can be used in the rapid identification of Dens Draconis and its adulterant.
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Objective:To study the influence of harvest time on the characters of Chaenomeles Spciosa ( Sweet) Nakai to determine the optimal harvest time with traditional characters of the Chinese medicine. Methods: In order to explore the optimal harvest time of Chaenomeles Spciosa ( Sweet) Nakai, the content of alcohol-soluble extract, weight and acidity of Chaenomeles Spciosa ( Sweet) Nakai with different harvest time were determined, the weather conditions in recent 3 years was summarized, and the drying process was also studied. Results:The average weight of Chaenomeles Spciosa(Sweet)Nakai was the lowest in June and highest in August, and the den-sity reached maximum in mid-July. During the whole harvest time, the content of alcohol-soluble extract was stable. The weather con-ditions from mid-July to late-July were with high temperature, dry and little rain, which was suitable for drying of Chaenomeles Spciosa ( Sweet) Nakai. Conclusion:The optimal harvest time of Chaenomeles Spciosa( Sweet) Nakai is confirmed in mid-July according to the traditional customs, drying conditions and characters of the Chinese medicine.
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Objective:To pharmacognostically identify Selaginellae uncinatae Herba to provide reference for the identification and utilization of Selaginellae uncinatae Herba. Methods:On the basis of observing the characters, structure and microscopic characteris-tics of the powder, Selaginella uncinata Herba was identified by a TLC method using amentoflavone as the reference substance. The contents of total ash, acid insoluble ash and alcohol-soluble extracts in Selaginellae uncinatae Herba were detected as well. Results:The morphological identification, microscopic identification and TLC identification of the herb was respectively established. The content limits of the total ash, acid insoluble ash and alcohol soluble extract were preliminarily determined. Conclusion:The studies provide reference for the identification and quality evaluation of Selaginellae uncinatae Herba.
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Objective:To establish the ISSR fingerprint of Chrysanthemum morifolium cultivated in Futianhe area of Macheng county to guide the breeding of C. morifolium. Methods:Using the technology of ISSR molecular markers and the software of SPSS 15. 0, the coefficient matrix of Jaccard was established and the tree graph of the genetic relationship of the breeds of C. morifolium cultivated in Fu-tianhe area was built to analyze the respective genetic relationship and features. Results:By ISSR analysis, it confirmed that C. morifoli-um in Futianhe area had long genetic distance with the other white chrysanthemum breeds, and it could be considered as an individual breed. Conclusion:The ISSR map can be used to identify the breed of C. morifolium cultivated in Futianhe area.
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This study was aimed to establish a qualitative model of near-infrared spectroscopy in order to accurately and rapidly identify several mineral Chinese medicinals from fossil including Os Draconis, Dens Draconis, Fossil Shell of Spirifer, and Fossil Crabs. The near-infrared diffuse reflectance spectroscopy combined with OPUS software was used to analyze the spectral characteristics of these samples. The pattern recognition method was explored through cluster analysis. And the accuracy of the model was verified. The results showed that these mineral Chinese medicinals from fossil had their characteristics absorption so that they can be quickly and accurately differentiated from each other through pattern recognition method. It was concluded that based on near-infrared spectroscopic mod-eling, these mineral Chinese medicinals from fossil including Os Draconis, Dens Draconis, Fossil Shell of Spirifer, and Fossil Crabs can be quickly and accurately identified.
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This study was aimed to explore a new method to identify the original plant of Plantaginis Semen and its adulterants by the ITS2 regions. The second internal transcribed spacer (ITS2) of ribosomal DNA was amplified and sequenced by bidirectional sequencing of PCR products. Sequence assembly and consensus sequence generation were performed by using CodonCode Aligner. The ITS2 secondary structure was predicted using ITS2 database and web-sites. The phylogenetic tree was constructed by MEGA5. The results showed that the maximum intraspecific K2P dis-tance of Plantago asiatica was 0.009 9, while the minimum interspecific K2P distance was 0.497 6; the maximum in-traspecific K2P distance of P. depressa was 0.005 2, while the minimum interspecific K2P distance was 0.519 1. The ITS2 secondary structure showed that P. asiatica and P. depressa can be differentiated obviously from its adulterants. Different samples of P. asiatica and P. depressa were gathered together and can be distinguished from its adulterants by NJ tree. It was concluded that the ITS2 sequence was able to identify original plant of Plantaginis Semen and its adulterants correctly. It provided a new method for the identification of original plant of Plantaginis Semen.