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Objective:To study the risk factors and prediction model of radiation pneumonitis (RP) after radical chemoradiotherapy for locally advanced esophageal cancer based on dosiomics.Methods:Clinical data of 105 patients with esophageal cancer undergoing radical chemoradiotherapy at Zhejiang Cancer Hospital between January 2020 and August 2021 were retrospectively analyzed. RP was scored using the National Cancer Institute's Common Terminology Criteria for Adverse Events version 5.0 (CTCAE 5.0). Clinical factors, traditional dosimetric features and dosiomics features were collected, respectively. The features for predicting PR were analyzed by limma package. Support vector machine, k-nearest neighbor, decision tree, random forest and extreme gradient boosting were used to establish the prediction model, and the ten-fold cross-validation method was employed to evaluate the performance of the model. The differences of this model when different features were chosen were analyzed by delong test.Results:The incidence of RP in the whole group was 21.9%. One clinical factor, 6 traditional dosimetric features and 42 dosiomics features were significantly correlated with the occurrence of RP (all P<0.05). Support vector machine using linear kernel function yielded the optimal prediction performance, and the area under the receiver operating characteristic (ROC) without and with dosiomics features was 0.72 and 0.75, respectively. The models established by support vector machine, random forest and extreme gradient boosting were significantly different with and without dosiomics features (all P<0.05). Conclusion:The addition of dosiomics features can effectively improve the performance of the prediction model of RP after radiotherapy for esophageal cancer.
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Objective To investigate the effect of intermittent high glucose on oxygen-glucose deprivation/refurnish (OGD/R) neuronal survival.Methods The primary cultured hippocampal neurons of mice were sub-cultured when the cell fusion reached about 80％.Cells in logarithmic growth phase were placed in a hypoxic incubator (37 ℃,5％ CO2,95％ N2) to simulate cell hypoxia.The culture medium was replaced by glucose-free Hank equilibrium salt solution (HBSS) to simulate cell hypoglycemia.The normal glucose and oxygen control group was set up.Cell morphology was observed under inverted phase contrast microscope after 6 hours of hypoxia and hypoglycemia treatment,and cell viability was detected by CCK-8 cell proliferation assay kit,and then grouping experiment was carried out.The cells were randomly divided into four groups.The cells were cultured in different concentration glucose medium under normal oxygen,5％ CO2 and 37 ℃ for 72 hours to prepare OGD/R model of cell ischemia/reperfusion.The low-glucose control group was cultured in medium containing 5.5 mmoFL glucose.The constant high-glucose group was cultured in medium containing 33.0 mmol/L glucose.The intermittent high-glucose group was cultured in medium containing 33.0 mmol/L glucose for 3 hours then in medium containing 5.5 mmol/L glucose for 2 hours alternately for 3 times during the day,and overnight in medium containing 33.0 mmol/L glucose at night.The hyperosmotic control group was made up of 5.5 mmol/L glucose medium and mannitol.The osmotic pressure was the same as that of the constant high-glucose group,and the effective glucose concentration was the same as that of the normal glucose and oxygen group,so as to eliminate the effect of osmotic pressure changes caused by the high-glucose medium on the results.Cell morphology was observed under inverted phase contrast microscope after 72 hours of cell culture in each group.Cell viability was measured by CCK-8 kit,and apoptotic rate was measured by flow cytometry.Results The inverted phase contrast microscope showed that the cells in the normal glucose and oxygen control group were plump and refractive,and had obvious nucleus,clear processes and high cell activity.After 6 hours of hypoxia and hypoglycemia treatment,the cells were shrunk,refractive index was poor,the nucleus was unclear,the processes were not clear,and the cell activity was significantly lower than that of normal glucose and oxygen control group (A value:0.34±0.06 vs.1.09±0.06,P ＜ 0.01),which indicated that the model of oxygen-glucose deprivation (OGD) was successfully prepared.After 72 hours of culture with different concentrations of glucose,the cells in the low-glucose control group were shrunk,the cell membrane was incomplete,the nucleus was unclear,and number of necrotic cells were more.In the constant high-glucose group,the refractive index of cells was poor,a large number of cells floated,and the nucleus was not obvious.In the intermittent high-glucose group,the cell morphology was normal,the refractive rate of cells was decreased slightly,and the necrotic cells were less.In the hypertonic control group,the cell status was close to that in the constant high-glucose group.Compared with the low-glucose control group or constant high-glucose group,the cell viability in the intermittent high-glucose group was significantly increased (A value:2.04±0.15 vs.0.64±0.18,1.16±0.16,both P ＜ 0.01),the apoptotic rate was significantly decreased [(59.60 ± 2.55)％ vs.(78.15 ± 15.77)％,(95.60± 0.14)％,both P ＜ 0.05].There was no significant difference in cell activity or apoptotic rate between the hypertonic control group and the constant high-glucose group [cell activity (A value):1.07 ± 0.07 vs.1.16 ± 0.16,apoptotic rate:(87.80 ± 4.53)％ vs.(95.60 ± 0.14)％,both P ＞ 0.05].Conclusion Intermittent high glucose within a certain range had protective effect on OGD/R neuronal survival.
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Objective To analyze the correlation between cerebral atrophy and white matter lesions (WML) in magnetic resonance imaging (MRI) by quantitative and qualitative methods. Methods Two hundred and seventy-two patients with WML admitted to the Department of Neurology of Taizhou Central Hospital from January 2015 to December 2017 were enrolled, by adopting MCMxxxVI 9.0 TM image processing tool and Analyze 9.0TM image editing tool, the volume within the skull, whole brain tissue, cerebrospinal fluid, subarachnoid volume on the surface of the brain, gray matter, normal brain white matter and diseased white matter were quantitatively determined in the MRI, Fazekas visual score was used to qualitatively evaluate the WML of MRI, and the correlation between brain atrophy and WML was analyzed. Results General linear model analysis showed that the WML volume had a negative correlation with total brain atrophy or decreased whole brain volume (β = -0.432, P = 0.004), especially with deep brain atrophy, namely WML volume had a significant positive correlation with the increase of ventricular volume (β = 0.098, P = 0.031), and it had no correlation with superficial brain atrophy or the increase of subarachnoid volume on the surface of the brain (β = 0.088, P = 0.547). Fazekas rating scale used for the correlation analysis of WML and brain atrophy also showed similar results. After adjusting for the gender and skull content volume, it was shown that the WML volume was well fitted with brain volume model, and so was the WML with the following volumes: cerebral white matter volume without any pathological changes, the whole brain tissue volume, gray matter volume models (brain volume R2 = 0.25, cerebral white matter volume with no pathological changes R2 = 0.35, whole brain tissue volume R2 = 0.77, gray matter volume R2 = 0.25, all P < 0.05). Conclusion MRI analysis showed WML was associated with brain atrophy, primarily with deep brain atrophy.
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Objective To explore the effect of lean management on cost control of single disease in patients with acute cerebral infarction (ACI) in stroke center. Methods A retrospective study was conducted. The patients with ACI who underwent intravenous thrombolysis in the stroke center of Taizhou Central Hospital in Zhejiang Province were enrolled. Thirty patients adopted traditional management procedures from July 2016 to September 2017 were enrolled in the control group, and 32 patients received lean management from October 2017 to December 2018 were enrolled in the lean group. The patients in the control group were treated with traditional intravenous thrombolysis, and the patients were sent to the neurology ward for intravenous thrombolysis. The patients in the lean group applied lean management value stream to optimize process management, the lean management team of the stroke center was established, and the green channel for stroke treatment was established to eliminate the waiting time as far as possible. The location of thrombolysis was changed from neurology ward to the neurological intensive care unit (NICU) in emergency department. The patients in the two groups were compared in terms of intravenous thrombolytic door-to-needle time (DNT), admission time to the neurologist's visit time (T1), CT examination time to neurology ward or NICU admission time (T2), neurology ward/NICU visit time to medication time (T3), and the proportion of patients with DNT controlled within 40 minutes, recovery of neurological impairment 7 days after thrombolysis [national institutes of health stroke scale (NIHSS) score], activity of daily living assessment (Barthel index), length of hospital stay, cost of hospital stay and patient satisfaction. At the same time, the main process quality and the implementation rate of easily missed indexes of cerebral infarction single disease were recorded. Results Compared with the control group, DNT, T1 and T2 in the lean group were significantly shortened [DNT (minutes): 39.56±11.12 vs. 63.03±19.63, T1 (minutes): 16.23±6.79 vs. 33.48±12.63, T2 (minutes): 13.45±3.84 vs. 17.47±5.56, all P < 0.01], T3 was slightly shortened (minutes: 9.88±1.95 vs. 10.95±2.69, P > 0.05), and the proportion of DNT control within 40 minutes was significantly increased [75.0% (24/32) vs. 16.7% (5/30), P < 0.01], the 7-day NIHSS score was decreased significantly (8.66±4.12 vs. 13.00±5.63, P < 0.01), 7-day Barthel index was increased significantly (71.6±16.7 vs. 54.7±17.1, P < 0.01), the length of hospital stay was significantly shortened (days: 9.69±4.06 vs. 12.47±3.83, P < 0.01), the hospital costs were significantly reduced (Yuan: 16 338±5 481 vs. 19 470±5 495, P < 0.05), the satisfaction of patients was improved significantly [(91.38±2.69)% vs. (86.53±2.78)%, P < 0.01]. In terms of the implementation rate of quality indicators such as pre-application evaluation of thrombolytic drugs, evaluation of dysphagia, and evaluation of vascular function, health education of ACI, rehabilitation evaluation and implementation within 24 hours, etc., the lean group was significantly improved as compared with the control group [(87.5% (28/32) vs. 53.3% (16/30), 96.9% (31/32) vs. 73.3% (22/30), 78.1% (25/32) vs. 43.3% (13/30), 100.0% (32/32) vs. 76.7% (23/30), 75.0% (24/32) vs. 33.3% (10/30), all P < 0.05]. Conclusion Lean thinking can realize the standardization of stroke center process, effectively utilize medical resources, improve medical quality and reduce the cost of cerebral infarction single disease.
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Objective To explore the effect of omni-directional health education on self-management level and blood glucose control in patients with type 2 diabetes mellitus. Methods A total of 100 diabetic patients admitted to the department of neurology of Taizhou Central Hospital from January to December 2016 were randomly divided into an observation group and a control group, 50 cases in each group. All patients were given conventional medication according to their systemic conditions, the control group used conventional nursing care, while the observation group was supplemented with omni-directional health education (including diet control therapy, exercise therapy, blood glucose control, hypoglycemic drug use and observation, foot care, blood glucose self monitoring) on the basis of routine nursing;the course of treatment was 2 weeks in the two groups. The differences in self-management level and the effect of blood glucose control were compared between the two groups. Results On the return visits, the self-management scores were significantly higher in both groups than those before education (the control group was 35.2±9.2 vs. 30.1±5.2, the observation group was 78.6±11.5 vs. 29.8±5.4, all P < 0.05), fasting blood glucose [FBG (mmol/L): the control group was 8.8±2.5 vs. 14.8±2.9, the observation group was 6.1±1.6 vs. 15.1±2.7, both P < 0.05) and 2 hours postprandial blood glucose [2 h PBG (mmol/L): the control group was 12.5±3.4 vs. 22.5±3.8, the observation group was 9.1±2.2 vs. 21.9±3.6) were obviously lower than those before education (all P < 0.05), the degrees of improvement of the observation group were more significant than those of the control group [self management score: 78.6±11.5 vs. 35.2±9.2, FBG (mmol/L): 6.1±1.6 vs. 8.8±2.5, 2 hours PBG (mmol/L): 9.1±2.2 vs. 12.5±3.4, all P < 0.05]. Conclusion Omni-directional health education can improve the self-management level of diabetic patients, and the patient's blood glucose control is relatively better.
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Objective To investigate the effects of X-ray beam hardening from contrast agent on CT values on CTA images.Methods The 20 mL syringes were numbered 1 to 26.The syringe 1,4,7,23 and 20 were filled with 1 mL,0.8 mL,0.6 mL,0.4 mL and 0.2 mL of iodine contrast medium (300 mg I/mL),respectively,and then mixed each of them with 0.9％ NaC1 solution to get a total of 20 mL solution in each syringe.The rest of 26 syringes were filled with 20 mL of 0.9％ NaC1 solution,as the experimental group to simulate carotid artery CTA examination.Matched 26 numbered syringes were filled with 20 mL 0.9％ NaC1 solution respectively,as control group to simulate plain scan.CT scans were performed,CT values were measured,and then the difference of CT values of 0.9 ％ NaCl solution in two groups was analyzed statistically.Results The mean,maximum and minimum CT values of saline in the experimental group vs control group were (-0.139±10.322) HU vs (5.585±2.939) HU,14.6 HU vs 9.7 HU,-23.8 HU vs-2.4 HU,respectively,and the differences were significant (t=2.695,P＜0.05).The CT values of saline around the high concentrations of iodine solution showed a large fluctuation range.Conclusion The X ray beam hardening effects caused by high concentration of iodine contrast on carotid artery CTA phase,may cause significant fluctuations of CT values.
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Objective To evaluate the high?risk factors for brain metastases after prophylactic cranial irradiation ( PCI), and to provide a basis for personalized treatment. Methods A retrospective analysis was performed in 188 patients with limited?stage small?cell lung cancer who received PCI in our hospital from 2005 to 2010. The Kaplan?Meier method was used to calculate the cumulative rate of brain metastases. The log?rank test and the Cox model were used for the univariate and multivariate analyses of the potential factors for the cumulative incidence of brain metastases, respectively. Results In the 188 patients, 31 ( 16?5%) had brain metastases. The 1?, 2?, and 3?year cumulative incidence rates of brain metastases were 4%, 15%, and 20%, respectively. The univariate analysis showed that staged Ⅲ disease before treatment, elevated levels of tumor markers, incomplete remission after chemoradiotherapy, and local?regional relapse were risk factors for high incidence of brain metastases ( P= 0?044, 0?037, 0?005, 0?007) . The multivariate analysis revealed that incomplete remission after chemoradiotherapy and local?regional relapse after chemoradiotherapy were risk factors for high incidence of brain metastases after PCI ( P= 0?003, 0?040 ) . Conclusions Patients with incomplete remission or local?regional relapse after chemoradiotherapy have high incidence of brain metastases after PCI. For those patients, a frequent follow?up of the central nervous system plus salvage cranial irradiation might provide an alternative to PCI.
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Objective To investigate the actuality of self-compassion and perceived social support among probationer nursing students, and to analyze the relationship between them. Methods 552 probationer nursing students from three tertiary hospitals in Suzhou were investigated by means of the Self-Compassion Scale (SCS) and Perceived Social Support Scale (PSSS). Results The probationer nursing students′ self-compassion and perceived social support was (3.20 ± 0.61) points and (5.81 ± 1.13) points, respectively. Scores of the total scale and the factors of self-compassion and perceived social support were positively correlated (r=0.485, P<0.01). Hierarchical regression analysis showed that perceived social support (family support and friend support) could be used to forecast the self-compassion of probationer nursing students and independently explain the variation of their self-compassion of 21.5%(△R2=0.215, P<0.01). Conclusions Self-compassion among probationer nursing students is in medium level, and perceived social support an important factor affecting their self-compassion.
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Objective To observe the effects of hirudo capsules on degree of platelet activation and blood rheology in patients with cerebral arteriosclerosis. Methods 122 patients with cerebral arteriosclerosis were randomly divided into two groups by the random number table:observation group(61 cases)and control group (61 cases). The two groups received conventional treatment such as antihypertensive and hypoglycemic drugs,and 100 mg of aspirin once a day. In the observation group,additionally hirudo capsules 0.75 g,3 times a day were given. The therapeutic course in both groups was 2 months. Prior to the start of treatment and on the next day after the end of treatment,traditional Chinese medicine(TCM)clinical syndrome integral,platelet membrane glycoproteins caspase 1 (PAC-1),platelet adhesion molecule P selection(CD62P)positive rate,and blood rheology indexes were detected,in addition to the adverse reactions . Results Before treatment,there were no statistical significant differences between the two groups in terms of TCM clinical syndrome integral such as headache,dizziness,head fullness,multiple somnolence amnesia,lip dark purple,sublingual veins purple in color,PAC-1,CD62P positive rate,hemorheology indexes(all P>0.05). After treatment,TCM clinical syndrome integral PAC-1,CD62P,low shear viscosity,high shear viscosity,plasma viscosity and the hematocrit of two groups were significantly lower than those before treatment, the improvement in observation group being more remarkable〔headache:0.75±0.69 vs. 1.23±0.92,dizziness:0.96±0.78 vs. 1.54±1.24,head fullness:0.65±0.59 vs. 1.48±1.17,multiple somnolence amnesia:0.77±0.72 vs. 1.69±1.14,lip dark purple:0.83±0.81 vs. 1.32±0.79,sublingual veins purple:0.84±0.67 vs. 1.20±0.74, PAC-1:(10.31±4.57)%vs.(15.13±6.27)%,CD62P:(11.39±5.24)%vs.(16.40±7.91)%,low shear viscosity (mPa?s):7.52±3.37 vs. 8.97±3.50,high shear viscosity(mPa?s):4.35±1.12 vs. 5.58±1.19,plasma viscosity (mPa?s):1.54±0.35 vs. 1.88±0.42,hematocrit(HCT):0.43±0.09 vs. 0.49±0.10〕. In the patients' follow-up, there were no obvious side effects of hirudo capsules. Conclusion Hirudo capsule is a safe and effective drug for treatment of patients with cerebral arteriosclerosis as it is helpful in reducing platelet activation degree and improving the blood rheology indexes.
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Objective To explore the early clinical characteristics of multiple system atrophy (MSA) in the elderly,and provide the basis for early diagnosis.Methods Totally 102 cases with probable MSA in elderly patients were retrospectively analyzed to understand the beginning symptom,clinical features and assistant examination results,combined with the literature review.Results Among the 102 cases diagnosed as probable MSA (61 cases were male and 41 cases were female),57cases (55.9％) were diagnosed as parkinsonism dominant MSA (MSA-P) subtype and 45 cases (44.1％) as cerebellar dominant MSA (MSA-C)subtype.In the beginning symptom,27 cases appeared autonomic dysfunction,including 15 cases (26.3％) in MSA P subtype and 12 cases (26.6％) MSA-C subtype; 14 cases manifested as dysuresia,11 cases as orthostatic hypotension,and 8 cases as sexual dysfunction.Parkinsonism as the beginning symptom was in 49 cases,among whom 24 cases were of abnormal gait,3 cases of resting tremor,16 cases of muscle rigidity,and 15 cases of slowed movement.Cerebellar symptoms as the beginning symptom were in 33 cases,with gait and limb ataxia of 27 cases,dysarthria of 6 cases,nystagmus of 2 cases.Pyramidal tract signs as the beginning symptom were in 2 cases.There was early misdiagnosis of 36 cases (35.3％).Conclusions As wide variety of early clinical features,MSA can be easily misdiagnosed.The clinical features and assistant examination should be paid attention to improvement of the accuracy of early diagnosis.
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Objective To investigate the correlation between matrix metalloproteinase-3 (MMP-3)serum level and polymorphism(5A/6A) and the stability of carotid plaque in Chinese Han population.Methods Two hundred and eighty acute cerebral infarction patients from the department of neurology of Taizhou Hospital were divided into carotid vulnerable plaque group and carotid stable plaque group according to the results of carotid B-mode uhrasonngraphy.Serum MMP-3 level waa measured by means of enzyme-linked immunosorbent assay (ELISA).At the same time, genotype was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for the common 5A/6A functional promoter polymorphism of the MMP-3 gene.The serum MMP-3 level and genotype frequencies of the MMP-3 gene between the two groups were analyzed.Results The genotype frequencies of the MMP-3 gene 5A/6A polymorphism of the two groups were in Hardy-Weinberg equilibrium The genotype distribution of the MMP-3 promoter 5A/6A polymorphism between the carotid vulnerable plaque group and the carotid stable plaque group was significantly different(χ2 =6.13, P =0.01, OR = 1.90, 95% CI 1.14-3.15).The frequencies of 5A allele were 20.6% and 12.8% in the carotid vulnerable plaque group and the carotid stable plaque group respectively (χ2=6.09, P=0.01, OR =1.76, 95%CI 1.12-2.77).Serum level of MMP-3 in the carotid vulnerable plaque group was higher than that in the carotid stable plaque group (t = 3.39, P =0.00).Conclusion The present findings suggest that serum level of MMP-3 and genetic polymorphism of 5A/6A in MMP-3 promoter are related with carotid vulnerable plaque in Chinese Han population and 5A allele may be a susceptible predictor of carotid vulnerable plaque.
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<p><b>OBJECTIVE</b>To investigate the association of matrix metalloproteinase-3 (MMP-3) serum level and the promoter 5A/6A polymorphism of the MMP-3 gene with atherosclerotic cerebral infarction (ACI) in a Chinese Han population.</p><p><b>METHODS</b>Two hundred and fifteen patients with acute ACI from the Department of Neurology of Taizhou Hospital and 226 healthy controls were included in the study. Serum MMP-3 level was measured by enzyme-linked immunosorbent assay (ELISA). Genotype was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for the common 5A/6A functional promoter polymorphism of the MMP-3 gene.</p><p><b>RESULTS</b>The genotype distribution of the MMP-3 promoter 5A/6A polymorphism between the ACI patients group and the control group was significantly different (chi (2)= 9.389, P= 0.002). The frequencies of the 5A allele were 14.2% and 7.7% in the ACI patients group and the control group respectively (chi (2)= 9.430, P= 0.002). Serum level of MMP-3 in the ACI patients group was significantly higher than that in the control group (t= 24.867, P= 0.000). Among the ACI patients group, serum MMP-3 levels also had significant difference between the 5A/6A+ 5A/5A and the 6A/6A genotype (t= 2.057, P= 0.041).</p><p><b>CONCLUSION</b>The present findings suggest that serum level of MMP-3 obviously increased within 48 hours of ischemic stroke and the genetic polymorphism of 5A/6A in the MMP-3 promoter is associated with ACI and MMP-3 expression in the Chinese Han population.</p>
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Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Povo Asiático , Genética , Estudos de Casos e Controles , Infarto Cerebral , Sangue , Genética , Etnicidade , Genética , Frequência do Gene , Genótipo , Arteriosclerose Intracraniana , Sangue , Genética , Metaloproteinase 3 da Matriz , Sangue , Genética , Polimorfismo Genético , Regiões Promotoras Genéticas , GenéticaRESUMO
Objective To investigate the relationship between acute cerebral infarction(CI)and matrix metalloproteinase-9(MMP-9)serum level and polymorphism(C-1562T)in Han population.Methods One hundred and one patients with acute CI from the department of neurology of Taizhou Hospital were included and 114 healthy persons were selected from physical examination as the control group.Serum MMP-9 level was measured by enzyme-linked immunosorbent assay(ELISA).At the same time.genotype was determined by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)for the common C-1562T functional promoter polymorphism of the MMP-9 gene.The serum MMP-9 level and genotype frequencies of the MMP-9 gene between the patients and the control group were analyzed.Results The genotype frequencies of the MMP-9 gene C-1562T polymorphism of the two groups were in Hardy-Weinberg equilibrium.The results of individual polymorphisms analysis showed that the frequencies of CT and TT genotypes in the C-1562T polyporphismin were of no significant difference between the patients group with CI(13.9%)and the control group(13.2%).The frequencies of-1562T allele was of no statistical difference between the CI group(6.9%)and the control group(7.5%).But serum levels of MMP-9 in CI patients group((138.9±121.8)ng/ml)were significantly higher than in the control group((18.4±4.6)ng/ml,t=9.93,P=0.00).Conclusions Serum level of MMP-9 obviously is increased after ischemic stroke in 48 hours.But genetic polymorphism in MMP-9 promoter(C-1562T)has no definite relationship with MMP-9 genetic expression and CI in the Han population of China.Therefore,the relationship between genetic polymorphism in MMP-9 promoter(C-1562T)and ischemic stroke needs further investigation.