The role of radiotherapy in patients with refractory Hodgkin’s lymphoma after treatment with brentuximab vedotin and/or immune checkpoint inhibitors

Background:Approximately 10%–30%of patients with Hodgkin’s lymphoma(HL)experience relapse or refractory(R/R)disease after first-line standard therapy.Brentuximab vedotin(BV)and immune checkpoint inhibitors(ICIs)have important roles in the salvage treatment of R/R HL.However,subsequent treatment for HL refractory to BV and/or ICI treatment is challenging.Methods:We retrospectively analyzed patients in two institutions who had R/R HL,experienced BV or ICI treatment failure,and received radiotherapy(RT)thereafter.The overall response rate(ORR),duration of response(DOR),progression-free survival(PFS),and overall survival(OS)were analyzed.Results:Overall,19 patients were enrolled.First-line systemic therapy comprised doxorubicin,bleomycin,vinblastine,and dacarbazine(ABVD,84.2%);AVD plus ICIs(10.5%);and bleomycin,etoposide,doxorubicin,cyclophosphamide,vincristine,procarbazine,and prednisone(BEACOPP,5.3%).After first-line therapy,15(78.9%)and four patients(21.1%)had refractory disease and relapsed,respectively.After R/R HL diagnosis,six(31.6%),two(10.5%),and 11(57.9%)patients received BV and ICIs concurrently,BV monotherapy,and ICI monotherapy,respectively.All patients received intensity-modulated RT(n=12,63.2%)or volumetric modulated arc therapy(VMAT;n=7,36.8%).The ORR as well as the complete response(CR)rate was 100%;the median DOR to RT was 17.2 months(range,7.9–46.7 months).Two patients showed progression outside the radiation field;one patient had extensive in-field,out-of-field,nodal,and extranodal relapse.With a median follow-up time of 16.2 months(range,9.2–23.2 months),the 1-year PFS and OS were 84.4%and 100%,respectively.PFS was associated with extranodal involvement(P=0.019)and gross tumor volume(P=0.044).All patients tolerated RT well without adverse events of grade≥3.Conclusion:RT is effective and safe for treating HL refractory to BV or ICIs and has the potential to be part of a comprehensive strategy for HL.

舍利与王权——武后对佛舍利的政治利用

引言武曌(623或625—705),其武则天之名更为人所知,在中国历史上独一无二。作为中国帝制历史上唯一的女帝,在唐朝国祚近三百年的时间里(618—907),她以非凡的成功统治了其中的六分之一:首先作为唐朝第三任皇帝高宗(649—683年在位)的皇后(655—683),然后作为她的太子睿宗(684—690)首次登基后的摄政王,最后作为名实俱在的一国之君(690—705)。

Correlation between muscular strength and basal nuclei ischemic/hemorrhagic stroke-induced corticospinal tract injury,as detected by diffusion tensor imaging and tractography

BACKGROUND： Conventional neuroimaging diagnosis does not assist with the monitoring or evaluation of basal nuclei ischemic and hemorrhagic stroke, or motor functional recovery. Magnetic resonance, diffusion tensor imaging, and diffusion tensor tractography have all been used to observe features of cerebral white matter fibrous structures. In addition, diffusion tensor tractography is the only non-invasive imaging method to display the corticospinal tract in vivo. OBJECTIVE： To evaluate the impairment degree of corticospinal tract induced by basal nuclei ischemic and hemorrhagic stroke through the use of magnetic resonance, diffusion tensor imaging, and diffusion tensor tractography, and to analyze the correlation to muscular strength. DESIGN, TIME AND SETTING： A retrospective case analysis was performed at the Department of Medical Imaging, Neurology and Neurosurgery, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA between November 2002 and June 2008. PARTICIPANTS： A total of 15 patients with acute or subacute cerebral ischemic stroke and nine with hemorrhagic stroke in the basal nuclei were selected. METHODS： Magnetic resonance, diffusion tensor imaging, and diffusion tensor tractography results and data were analyzed. Fractional anisotropy and directionally encoded color maps were obtained. Three-dimensional tractography of bilateral corticospinal tract was created, and corticospinal tract integrity was graded. Fractional anisotropy of infarct region and corresponding contralateral normal regions were measured, and hematoma volume in hemorrhagic stroke patients was determined. Hand motor function ability was evaluated using Brunstorm criteria. MAIN OUTCOME MEASURES： Fractional anisotropy of infarct region and corresponding contralateral normal regions; hematoma volume in hemorrhagic stroke patients; correlation between muscular strength and corticospinal tract impairment degree in ischemic stroke and hemorrhagic stroke patients before and after treatment. RESULTS： In ischemic stroke patients, the fractional anisotropy value was significantly lower in the infarct area of white matter than in the normal hemisphere （P 〈 0.01）. The impairment degree of corticospinal tract negatively correlated with muscular strength of the corresponding hand （r = -0.97 P 〈 0.01）. The hematoma volume of hemorrhagic stroke patients significantly negatively correlated with Spearman test results for muscular strength of the corresponding hand （r = -0.88, P 〈 0.01）. CONCLUSION： Corticospinal tract impairment severity negatively correlated with muscular strength and motor functional recovery, which suggested that diffusion tensor imaging and diffusion tensor tractography could be used to evaluate corticospinal tract motor function.

Effective Capacity in Cognitive Radio Networks with Relay and Primary User Emulator

In this paper,the transmission performances are studied in cognitive radio networks with primary user emulator and relay existence.In the proposed network,the users include primary users,secondary users and primary user emulators.The decreasing access priority of the users are primary users,primary user emulators and secondary users.Different user access to the network results in different transmission effects.We impose interference power constraints on the secondary users to protect the primary users from being interfered.We also adopt the transmission mechanism that transits among more than one secondary transmitters,secondary receivers and relays.The transition models of the transmission states are proposed to describe the transmission mechanism.To investigate the transmission performances,the theory of effective capacity is adopted.The transmission performances in terms of effective capacity are expressed and demonstrated under different transmission policies.The overall effective capacity,as the overall data traffic in the cognitive radio network,is calculated.Besides,the overall effective capacity is demonstrated under different transmission strategies.The results show the greedy transmission strategy outperforms the rest of the transmission 8 policies in the overall effective capacity.For a larger number of the users,the effective capacity converges to a certain value.

Changes in brain function and anatomical structure following treatment of hyperbaric oxygen for visual pathway abnormalities in 16 cases Evaluation of functional magnetic resonance imaging combined with diffusion tensor imaging

BACKGROUND： There is a growing research focus on the combination of blood oxygenation level dependent functional magnetic resonance imaging （BOLD-fMRI） and diffusion tensor imaging （DTI） to evaluate visual cortical function and structural changes in the cerebrum, as well as morphological changes to the white matter fiber tracks, after visual pathway lesions. However, the combined application of BOLD-fMRI and DTI in treating of visual pathway abnormalities still requires further studies. OBJECTIVE： To observe and evaluate the effects of hyperbaric oxygen on visual pathway abnormalities, and to evaluate the characteristics of cerebral function and anatomic structural changes by using BOLD-fMRI combined with DTI technique. DESIGN： Case contrast observation. SETTING： Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. PARTICIPANTS： Sixteen patients （9 males and 7 females, 15-77 years old） with lateral or bilateral visual disorder induced by visual pathway lesions were selected from the Department of Neurology, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from January 2006 to May 2007. These patients comprised the lesion group. Measures of interventional therapy： hyperbaric oxygen of two normal atmospheres for three courses （10 d/course） and routine internal medicine treatment. In addition, 12 healthy subjects of similar sex and age to the lesion group were regarded as the control group. The control group underwent routine ophthalmological and ocular fundus examinations; diagnostic results were normal. The experiment received confirmed consent from the local ethic committee, and all patients provided informed consent. METHODS： BOLD-fMRI and DTI manifestations in the lesion group were observed before and after hyperbaric oxygen intervention, and the results were compared with the control group. The subjects were positioned on their back, and BOLD-fMRI images were collected with the following GRE EPI sequence： TR = 2 000 ms, TE = 40 ms, layer thickness = 5 mm, and 20-layer successive scanning to cover the whole brain. While, DTI images were collected with SE EPI sequence of single excitation： TR=10 000 ms, TE = 112 ms, layer thickness = 4 mm, layer spacing = 0.5 mm, and a 30-layer successive scanning, matrix = 128×128. A diffusion gradient was applied at 13 directions, and one layer without diffusion weighted imaging was collected at b =1 000 s/mm^2. Numbers of activated voxels in cortical-activated regions, and fractional anisotropy in bilateral cerebral optical radiation regions, were calculated. Displacement, continuity, and destruction of fibrous tracts were analyzed. MAIN OUTCOME MEASURES： Results of BOLD-fMRI and DTI examinations. RESULTS： All 16 patients and 12 controls were included in the final analysis. ① Numbers of activated voxels through the use of BOLD-fMRI： prior to hyperbaric oxygen therapy, the number of activated voxels in the bilateral cortex of occipital lobe were significantly less in the lesion group than in the control group （t =3.23, P 〈 0.01）. In addition, the number of activated voxels significantly increased after treatment compared to before treatment （t = 2.46, P 〈 0.05）. ② Fractional anisotropy in optical radiation regions of bilateral cerebrum： fractional anisotropy in the lesion group was significantly less than the control group （t =2.89, P 〈 0.05）. In addition, fractional anisotropy after treatment was significantly higher than before treatment （t = 2.48, P 〈 0.05）. Moreover, fractional anisotropy of optical neuropathy was significantly higher in 6 patients in the lesion group than the occipital lobe optical central lesion （t = 2.35, P 〈 0.05）. CONCLUSION： BOLD-fMRI combined with DTI can indicate the occurrence, development, and therapeutic course of action for optical pathway lesions. The results acquired from these methods can provide information for function and structure, which can provide reliable verification in the treatment of cerebral function.

Characters of MR diffusion tensor imaging in cerebral ischemic corticospinal tract injury

BACKGROUND： Diffusion tensor imaging （DTI） is one of the noninvasive methods to study the morphological structure of brain white matter fibrous bands in vivo, and it has been applied primarily in clinic. DTI is acknowledged as the more effective imaging method to diagnose ultra-acute and/or acute cerebral infarction.OB_3ECTIVE： To observe the anisotropic characters of cerebral white matter fibrous bands in patients with ischemic stroke by using DTI, and investigate the correlation between the damage of corticospinal tract and muscle strength in patients with ischemic stroke at acute period.DESIGN： A case-control observationSEFIING： Department of Medical Imaging, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.PARTICIPANTS： Nine inpatients with injury of motor function induced by acute ischemic stroke （patient group） at 6 hours to 2 weeks after the attack were selected from the Department of Neurology, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from September 2005 to March 2006, and they all accorded with the present diagnostic standard for cerebrovascular disease in China. There were 5 males and 4 females, aged 16-87 years. At the same time, nine healthy right-handed physical examinees matched by age and sex with the patients were taken as the control group, and they all had no nervous disease, mental diseases, cerebrovascular abnormalities and injury history, etc. All the subjects were informed with the detected items and agreed to participate in the study.METHODS： All the 9 patients with ischemic stroke at acute period and 9 healthy subjects were examined with MRI, T1 weighted imaging, T2 weighted imaging and DTI. And the data were processed offline with dTV.II software, the images of fractional anisotropy and directional encoded color （DEC） were obtained, and the three-dimensional fibrous band images of bilateral corticospinal tracts were reconstructed. In the control group, the values of fractional anisotropy of main white matter fibrous bands were measured in the region of interest （ROI） of the anterior limb, knee and posterior limb of internal capsule. In the patient group, the values of fractional anisotropy of white matter were measured in the infarcted sites and corresponding contralateral sites of the patients. The ROI was set in bilateral cerebral peduncles to reconstruct three-dimensionally the bilateral corticospinal tracts. The muscle strength of the affected hand was assessed with Brunnstorm standard in the stroke patients.MAIN OUTCOME MEASURES ： The characters of DTI and images of the value of fractional anisotropy, and the manifestations of three-dimensional corticospinal tracts were observed in the two groups.RESULTS： All the data from the 9 patients and 9 healthy volunteers were involved in the analysis of results. In the control group, the white matter and gray matter could be distinguished clearly in the image of fractional anisotropic values, the fibers of different directions were shown by different colors in DEC picture, which clearly demonstrated the normal anatomic structure and direction of white matter fibers. In the patient group, the infarctions occurred in the gray matter or white matter could be distinguished in the images of fractional anisotropic values, DEC picture could clearly show the direct influence of the infarcted site on the white matter fibers. The fractional anisotropic values in different white matter structure of the same side were significantly different in the control group （t=-3.12, P 〈 0.05）, and the reconstructed images fractional anisotropic values and DEC picture could show most of the main white matter fibrous bands. The fractional anisotropic values of the infarcted sites were significantly lower than the contralateral ones in the patient group （t=-5.570, P 〈 0.01）. ② The reconstructed bilateral corticospinal tracts showed that the anatomic forms of the contralateral corticospinal tract of the patients were almost identical to those of normal people, it started from precentral gyrus, downward to the nternal capsule, and extended to pontine and medulla oblongata, each fibrous band was continuous, and the form had good consistency. Because of the involvement of infarction of different severity, the ipsilateral corticospinal tract manifested as continuous interruption and the loss of consistent anatomic structural form. The involved severity of corticospinal tract had significant correlation with that of muscle strength of the ipsilateral hand （r=-1.30, P 〈 0.01）.CONCLUSION： ① DTI can display the direction and distribution of cerebral white matter fibrous bands.② DTI images of fractional anisotropic values and DEC can show the directions and anisotropic degree of white matter fibers in the infarcted sites of stroke patients. ③ The three-dimensional images of fibrous bands can show the conditions of pyramidal tracts more directly. ④ The damaged severity of corticospinal tracts is correlated with that of muscle strength.

Observation of activation status of motor-related cortex of patients with acute ischemic stroke through functional magnetic resonance imaging

BACKGROUND： About more than three fourth of patients with stroke have motor dysfunction at different degrees, especially hand motor dysfunction. Functional magnetic resonance imaging （fMRI） provides very reliable visible evidence for studying central mechanism of motor dysfunction after stroke, and has guiding and applicable value for clinical therapy. OBJECTIVE： To observe the activation of motor-related cortex of patients with acute ischemic stroke with functional magnetic resonance imaging, and analyze the relationship between brain function reconstruction and motor restoration after stroke. DESIGN ： A contrast observation SETTING： Medical Imaging Center, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. PARTICIPANTS ： Nine patients with acute ischemic stroke who suffered from motor dysfunction and received the treatment in the Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA between August and December 2005 were recruited, serving as experimental group. The involved patients including 5 male and 4 female, aged 16 to 87 years, all met the diagnostic criteria of cerebrovascular disease revised by The Fourth National Conference on Cerebrovascular Disease, mainly presenting paralysis in clinic, and underwent fMRI. Another 9 right handed persons matched in age and gender who simultaneously received healthy body examination were recruited, serving as control group. All the subjects were informed of the detected items. METHODS ： ①Muscular strength of patients of the experimental group was evaluated according to Brunnstrom grading muscular strength （Grade Ⅰ -Ⅳ）. ②Passive finger to finger motion was used as the mission （alternate style of quiescence, left hand motion and quiescence, nght hand motion was repeated 3 times, serving as 1 sequence, 20 s per block and 20 s time interval. The whole process of scanning was 260 s）, and subjects of 2 groups were given Bold-fMRI examination with GEl .5T double gradient 16-channel magnetic resonance imaging system. All the data were given off-line management, and fMRI was treated with SPM2 softwere. The activation of passive finger-to-finger motion-related cortex of subjects in 2 groups was observed. ③ Results of fMRI of subjects in 2 groups were compared. The size of activation region of brain and signal intensity were measured and unilateral index was calculated. The data of activation region of cerebral hemisphere of different sides at finger motion were given statistical analysis of unilateral index. Differences among unilateral indexes at hand motion were compared between intact and affected hands of patients in experimental group. The relationship between unilateral index and muscular strength of affected hands at affected hand motion in patients of the experimental group was performed Spearman correlation analysis. MAIN OUTCOME MEASURES： ① The activation of motion-related cortex passive finger-to-finger motion between handedness and non-handedness was detected with functional magnetic resonance imaging of subjects in 2 groups. ②Relationship between unilateral index and muscular strength of subjects of experimental group at affected hand motion. RESULTS： Nine patients with ischemic stroke and 9 controls all participated in the final result analysis. ① Passive fMRI detection results between handedness and non-handedness of controls： Right-handed finger-to-finger motion of subjects of control group mainly activated contralateral sensonmotor cortex, and left-handed finger-to-finger motion not only activated above-mentioned brain region, but also activated supplementary motor area （SMA） of contralateral brain region; ②In the experimental group, sensorimotor cortex of contralateral hemisphere was activated at affected hand motion, and homolateral posterior parietal cortex （PPC）was also obviously activated. Bilateral sensonmotor cortex was activated at affected hand motion in 2 patients, and homolateral activation area was larger than contralateral one. At intact hand motion, contralateral sensorimotor cortex was activated, but no obvious homolateral activation area was found. ③ Correlation of unilateral index with muscular strength： Passive finger-to-finger fMRI （ between affected and intact hands of subjects of experimental group： Unilateral index at passive single finger motion of affected and intact hand of subjects of experimental group was -0.018±0.01 and 0.319±0.187, respectively, with significant difference （t=4.059, P 〈 0.01 ）. Unilateral index was significantly positively correlated with the muscular strength of affected hand at affected hand motion（r=0.834, P 〈 0.05）.CONCLUSION ： ①fMRI can objectively shows different activation states of motor cortex between patients with ischemic stroke and healthy controls, and brain functional compensation and recombination exist. Both primary sensorimotor cortex and SMA of bilateral hemispheres participant in affected hand motion, at the same time, parietal lobe and cortex of intact side also obviously participant in the affected hand motion. ②Correlation analysis of unilateral index and muscular strength of affected hand performed through fMRI can be used as an effective means to investigate the relationship between motion rehabilitation and brain functional recombination after stroke.

Review on the Sensor Technology Applied in the Intelligent Learning Environment

The development of sensor technology promotes the transformation of the intelligent learning environment. Through the research of the sensor technology application, this paper described the intelligent learning environment application system of the sensor technology and the management functions, conference organization, a library building, information collection, monitoring and equipment sharing function the role of sensor technology played in the intelligent learning environment.

Jin Chengyu ed., Hekeben Zhongguo guyishu congkan （A Series of Ancient Chinese Books Missing from China but Preserved and Printed in Japan）

China has long boasted a time-honored tradition of reverence for books, but this tradition has been subject to periodic countercurrents that have occasionally led to the widespread, deliberate destruction of books by political authorities. The two most notorious historical examples of this phenomenon are the massive book-burning carried out by the First Emperor of the Qin dynasty,

Reversibly size-switchable polyion complex micelles for antiangiogenic cancer therapy

Size is one of the most important characteristics of nanoparticles to influence their biodistribution and antitumoral efficacy.Particles with large sizes have difficulty in deep tumor penetration,while small particles are easily removed from tumor tissues due to the high tumor interstitial fluid pressure.To address these issues,an intelligent core-crosslinked polyion complex micelle(cPCM)with a reversibly sizeswitchable feature was engineered in this study.The micelles are consisting of methoxy poly(ethylene glycol)-poly(D,L-lactide)copolymer(mPEG-PLA),mPEG-PLA-(HE)6CC,and mPEG-PLA-(RG)6CC at an optimal mass ratio of 6:1:1 with an antiangiogenic compound,dabigatran etexilate(DE),encapsulated.The net charge inside the micelles is switchable when exposed to different pH conditions,thereby leading to revisable size-change of micelles.DE-loaded micelles(DE@cPCM)can swell and release drugs at the tumor sites with a mildly acidic pH,while they shrink and protect the cargo from leaking into the blood circulation with a neutral pH.Results indicated that DE@cPCM can inhibit tumor angiogenesis in vitro and in vivo,thereby efficiently restraining tumor growth in a 4T1-bearing mouse model.Collectively,the sizeswitchable cPCM is a promising nanoplatform for targeting delivery of anticarcinogens into the matrix of tumor tissues.

Hydraulic piston pump in civil aircraft: Current status, future directions and critical technologies

The piston pump is the key power component in the civil aircraft hydraulic system,and the most common pump used in the aviation field is the pressure compensated variable displacement type.In this review paper,a basic introduction to the civil aircraft piston pump is presented,including the classification,structure,working principle,design features,and achievements by some research groups.Then,the future directions of the aircraft pump are reported from various perspectives.Further,the critical technologies are analyzed and summarized in detail from six thrust areas:friction couples,noise reduction,inlet boost,thermal management,fault diagnosis and health management,and mechanical seal.Finally,the challenges and limitations of the research on the aircraft pump are discussed to provide valuable insight for future scholars.

Up-regulation of glycolipid transfer protein by bicyclol causes spontaneous restriction of hepatitis C virus replication

Bicyclol is a synthetic drug for hepatoprotection in clinic since 2004. Preliminary clinical observations suggest that bicyclol might be active against hepatitis C virus(HCV) with unknown mechanism. Here, we showed that bicyclol significantly inhibited HCV replication in vitro and in hepatitis C patients. Using bicyclol as a probe, we identified glycolipid transfer protein(GLTP) to be a novel restrictive factor for HCV replication. The GLTP preferentially bound host vesicle-associated membrane protein-associated protein-A(VAP-A) in competition with the HCV NS5 A, causing an interruption of the complex formation between VAP-A and HCV NS5 A. As the formation of VAP-A/NS5 A complex is essential for viral RNA replication, up-regulation of GLTP by bicyclol reduced the level of VAP-A/NS5 A complex and thus inhibited HCV replication. Bicyclol also exhibited an inhibition on HCV variants resistant to direct-acting antiviral agents(DAAs) with an efficacy identical to that on wild type HCV. In combination with bicyclol, DAAs inhibited HCV replication in a synergistic fashion. GLTP appears to be a newly discovered host restrictive factor for HCV replication, Up-regulation of GLTP causes spontaneous restriction of HCV replication.

Evaluating ischemic stroke with diffusion tensor imaging

Objective:In recent years,diffusion tensor imaging (DTI) has emerged as a promising tool to study ischemic stroke. The aim of this study is to evaluate the anisotropic changes of cerebral white matter tracks in patients with ischemic stroke using DTI,and investigate the correlation between corticospinal tract damage and muscle strength in such patients during acute ischemia.Method:9 patients with acute ischemic stroke and 9 healthy subjects were examined with T1 weighted magnetic resonance imaging (MRI),T2 weighted MRI and DTI. Fractional anisotropy (FA) was measured and the three-dimensional fibrous band images of bilateral corticospinal tracts were reconstructed. The muscle strength of the affected hand was assessed by Brunnstorm standard[1],which is an internationally recognized measure of movement in hemiplegic patients.Results:①In the control group,there was no significant difference in FA between the bilateral corticospinal tracts,but FA in different white matter structure of the same side was significantly different (t=3.12,P < 0.05). FA of posterior limb of internal capsule was higher than that of knee and anterior limb of internal capsule,FA of anterior limb of internal capsule was the lowest. while in the patient group,FA of the infarcted sites was significantly lower than the contralateral ones (t=5.570,P < 0.01). ②The ipsilateral corticospinal tract demonstrated continuous interruption and the loss of consistent anatomic structure. The involved severity of corticospinal tract had significant correlation with that of muscle strength of the ipsilateral hand (r=0.83,P < 0.01).Conclusion:This study shows that DTI can be used to investigate ischemic stroke and assess ischemic stroke-induced damage. The damaged severity of corticospinal tracts is correlated with that of muscle strength.

From Central Asia to Southern China： The Formation of Identity and Network in the Meditative Traditions of the Fifth--Sixth Century Southern China （420--589）

Focusing on two specific areas in southern China, Jinling and Jingzhou, this paper examines the meditation traditions in southern China during the two-century period between 400 and 600. The activities of the main meditation practitioners based in Jinling and Jingzhou are traced, for which it will be shown that most of them were related, in one way or the other, to Buddhabhadra （359-429）, an Indian missionary- cum-translator who arrived in Chang＇an in 404 or 408 via Kashmir. Following Bud- dhabhadra, several of Buddhabhadra＇s disciples and second-generation disciples, also arrived in Jinling. A review of the meditation tradition in Jinling reveals that the Kashmiri meditation tradition brought by Buddhabhadra and his group formed a dominant and decisive force for the formation and development of the meditation tradition in that area. Similarly, a survey of the meditation traditions of the Jingchu and Jingzhou area shows the same dominant influence of Buddhabhadra＇s Kashmiri med- itative tradition. Evidence further demonstrates that throughout the four southern dynasties （Song, Qi, Liang, and Chen）, the two meditation traditions in Jinling and Jingzhou maintained very close and frequent contacts. An investigation into the med- itation tradition based on the Jing-Chu area evolved around Huisi and his group. Huisi seems to be a key point of connections between the Jinling and the Jingzhou meditation traditions. His influence on the Jingzhou meditative tradition is demonstrated by the fact that almost all of his disciples known to us were connected to the meditation tradition at that area. We will moreover show that Huisi＇s contact with the southern meditative traditions, centered around the areas of Jinling, Mount Lu and Jingzhou, had actually began much earlier than it has been assumed. Though already forgotten in this respect, the Kashmiri meditation tradition brought to China by Buddhabhadra, when viewed in a broader context, played a surprisingly significant role in the evolution of the meditation tradition in early medieval China. Identity might have been, and was indeed, carried ondefying apparently insurmountable geographic and cultural barriers, while networks were created and maintained when and where they were least expected. Finally, by calling into question the general claim for the ＂Mahayanist＂ nature of most Chinese （or even East Asian） Buddhist traditions, this essay has underscored the necessity of broadening the intellectual perspectives for evaluating the provenance, nature, and functions of quite a number of Buddhist traditions in East Asia that have been so far uncritically subjugated to the general rubric of ＂Mahayana.＂

厄他培南预防直肠癌高危手术部位感染的临床疗效分析

目的探讨厄他培南预防直肠癌术后手术部位感染的临床疗效及其影响因素分析。方法选取2010年3月到2022年3月在福建医科大学附属协和医院结直肠外科术前应用抗生素预防手术部位感染的直肠癌患者775例;通过倾向性评分匹配(PSM)后,共纳入230例术前应用抗生素预防手术部位感染的直肠癌患者,厄他培南组46例、非厄他培南组184例,对比厄他培南组和非厄他培南组预防直肠癌手术部位感染的疗效;采用Logistic回归单、多因素分析直肠癌手术部位感染的危险因素。结果厄他培南组患者表浅手术部位感染发生率低于非厄他培南组(8.7%vs.22.3%,P=0.038);单因素分析发现厄他培南(OR=4.317,P=0.038)、手术方式(P=0.0001)、肿瘤距离肛缘的距离(OR=0.718,P=0.011)、手术时间(OR=1.010,P=0.002)与直肠癌术后表浅手术部位感染密切相关;多因素分析结果表明:非厄他培南(OR=4.392,95%CI:1.325~14.564;P=0.016)、手术方式(APR手术,OR=25.65,95%CI:2.960~222.37;P=0.003)、手术时间(OR=1.011,95%CI:0.003~1.019;P=0.004)是直肠癌术后表浅手术部位感染的独立危险因素。结论厄他培南比非厄他培南组更有效预防直肠癌表浅手术部位感染,APR手术和手术时间长的直肠癌患者应积极应用厄他培南预防手术部位感染。