A model to predict the risk of lethal nasopharyngeal necrosis after re-irradiation with intensity-modulated radiotherapy in nasopharyngeal carcinoma patients

Background:For patients with nasopharyngeal carcinoma(NPC) who undergo re-irradiation with intensity-modulated radiotherapy(IMRT),lethal nasopharyngeal necrosis(LNN) is a severe late adverse event.The purpose of this study was to identify risk factors for LNN and develop a model to predict LNN after radical re-irradiation with IMRT in patients with recurrent NPC.Methods:Patients who underwent radical re-irradiation with IMRT for locally recurrent NPC between March 2001 and December 2011 and who had no evidence of distant metastasis were included in this study.Clinical characteristics,including recurrent carcinoma conditions and dosimetric features,were evaluated as candidate risk factors for LNN.Logistic regression analysis was used to identify independent risk factors and construct the predictive scoring model.Results:Among 228 patients enrolled in this study,204 were at risk of developing LNN based on risk analysis.Of the 204 patients treated,31(15.2%) developed LNN.Logistic regression analysis showed that female sex(P = 0.008),necrosis before re-irradiation(P = 0.008),accumulated total prescription dose to the gross tumor volume(GTV) ≥ 145.5 Gy(P = 0.043),and recurrent tumor volume >25.38 cm3(P = 0.009) were independent risk factors for LNN.A model to predict LNN was then constructed that included these four independent risk factors.Conclusions:A model that includes sex,necrosis before re-irradiation,accumulated total prescription dose to GTV,and recurrent tumor volume can effectively predict the risk of developing LNN in NPC patients who undergo radical re-irradiation with IMRT.

Estimation of Probability of Unprotected Heterosexual Vaginal Transmission of HIV-1 from Clients to Female Sex Workers in Kaiyuan,Yunnan Province, China

Objective To estimate the probability of unprotected heterosexual vaginal transmission of HIV-1 from clients to Female Sex Workers （FSWs） in Kaiyuan County, Yunnan province, China, and analyze factors which impact the transmission probability. Methods An open cohort research of FSWs in Kaiyuan was created from surveys conducted in April 2008, October 2008, and April 2009. Two cross-sectional surveys of local clients were also carried out in May 2008 and November 2008. A model was developed to estimate the probability of unprotected heterosexual vaginal transmission of HIV-1 from clients to FSWs. Results The transmission probability from clients to FSWs was estimated as 0.0023 [95% CI 0.0014-0.0032] per unprotected heterosexual act. Conclusion The transmission probability among this group engaging in commercial sex in Yunnan province differs from that found in studies from other countries, and future studies should estimate the influence factors of HIV-1 transmission probability, such as stage of HIV infection, co-morbid sexually transmitted infections （STIs）.

彩色多普勒超声对乳腺癌微钙化的诊断价值及微钙化与预后的关系

目的探讨彩色多普勒超声对乳腺癌微钙化的诊断价值并分析微钙化与预后的关系。方法回顾性分析2017年6月—2018年6月天津医科大学肿瘤医院收治的乳腺癌患者420例临床资料。以术后病理诊断为金标准,评估彩色多普勒超声对微钙化的诊断效能。根据预后情况,将420例患者分为预后良好组(346例)和预后不良组(74例),采用单因素分析及多因素Logistics回归分析探究乳腺癌患者预后不良的危险因素。结果超声微钙化影像学特点主要表现为肿块内部及其周边存在点状强回声,以及乳腺腺体内可见沿导管走形方向分布的点状强回声;伴钙化的肿块表现为边缘不光整,形态不规则,边缘毛刺,部分纵横比>1。其中部分微钙化患者腺体内沿导管走形方向分布的强回声光点,该类钙化提示可能有导管内癌或原位癌,患者预后较好;超声诊断乳腺癌微钙化的准确率为71.4%(95%CI:0.672,0.845),敏感性为74.2%(95%CI:0.703,0.871),特异性为62.8%(95%CI:0.575,0.726),阳性预测值为86.1%(95%CI:0.744,0.943),阴性预测值为43.8%(95%CI:0.363,0.579)。多因素Logistic回归分析结果显示:肿瘤直径≥2 cm[O^R=2.401(95%CI:1.105,5.216)]、有淋巴结转移[O^R=2.583(95%CI:1.494,4.466)]、微钙化[O^R=5.376(95%CI:2.105,13.729)]是乳腺癌患者术后预后不良的危险因素(P<0.05);TNM分期为Ⅰ、Ⅱ期[O^R=0.269(95%CI:0.160,0.452)]、术后放疗[O^R=0.345(95%CI:0.202,0.590)]、术后化疗[O^R=0.310(95%CI:0.179,0.537)]是乳腺癌患者术后预后不良的保护因素(P<0.05)。结论彩色多普勒超声对乳腺癌微钙化具有一定诊断价值。乳腺癌手术患者预后受多种因素影响,微钙化是患者预后不良的独立影响因素。

Indoleamine-2,3-dioxygenase 1/cyclooxygenase 2 expression prediction for adverse prognosis in colorectal cancer

AIM To evaluate indoleamine-2,3-dioxygenase 1/cyclooxygenase 2(IDO1/COX2) expression as an independent prognostic biomarker for colorectal cancer(CRC) patients.METHODS We retrospectively studied the medical records of 95 patients who received surgical resection from August 2008 to January 2010. All patients were randomly assigned to adjuvant treatment with or without celecoxib groups after surgery. We performed standard immunohistochemistry to assess the expression levels of IDO1/COX2 and evaluated the correlation of IDO1/COX2 with clinicopathological factors and overall survival(OS) outcomes.RESULTS The expression of nuclear IDO1 was significantly correlated with body mass index(P < 0.001), and IDO1 expression displayed no association with sex, age, tumor differentiation, T stage, N stage, carcinoembryonic antigen, cancer antigen 19-9, CD3+ and CD8+ tumor infiltrating lymphocytes, and COX2. In univariate analysis, we found that nuclear IDO1(P = 0.039), nuclear/cytoplasmic IDO1 [hazard ratio(HR) = 2.044, 95% confidence interval(CI): 0.871-4.798, P = 0.039], nuclear IDO1/COX2(HR = 3.048, 95%CI: 0.868-10.7, P = 0.0049) and cytoplasmic IDO1/COX2(HR = 2.109, 95%CI: 0.976-4.558, P = 0.022) all yielded significantly poor OS outcomes. Nuclear IDO1(P = 0.041), nuclear/cytoplasmic IDO1(HR = 3.023, 95%CI: 0.585-15.61, P = 0.041) and cytoplasmic IDO1/COX2(HR = 2.740, 95%CI: 0.764-9.831, P = 0.038) have significantly poor OS outcomes for the CRC celecoxib subgroup. In our multivariate Cox model, high coexpression of cytoplasmic IDO1/COX2 was found to be an independent predictor of poor outcome in CRC(HR = 2.218, 95%CI: 1.011-4.48, P = 0.047) and celecoxib subgroup patients(HR = 3.210, 95%CI: 1.074-9.590, P = 0.037).CONCLUSION Our results showed that cytoplasmic IDO1/COX2 coexpression could be used as an independent poor predictor for OS in CRC.

Comparison of epidemiological characteristics COVID-19 Delta variant infection among children in Xi'an and Baoji

Objective:To explore the epidemiological characteristics of Corona Virus Disease 2019(COVID-19)Delta variant infection in children in Xi'an and Baoji.Methods:According to the official information released by Shaanxi Province,the information of confirmed cases in Xi'an(December 20,2021 to January 8,2022)and Baoji(March 8 to March 27,2022)were collected respectively.Records include age,sex,residential address,community and other basic information.Isolation mode,isolation time,morbidity and positive time of viral nucleic acid test,vaccination,clinical typing,close contact personnel,cluster incidence situation and the social activity tracking of the confirmed cases were collected,and the data were statistically analyzed.Results:In 20 days,there were 281 infected children in Xi'an,accounting for 14.48%of the total cases(1,940 cases),including 154 boys(54.8%)and 127 girls(45.20%).The number of diagnosed children in Baoji City(55 cases)is 19.57%of that in Xi'an(55/281),but accounts for 23.31%of the total number of cases(236 cases)in Baoji(this ratio is higher than that of 14.48%in Xi'an).Among the 55 cases of children,there are 33 males(60.00%)and 22 females(40.00%).The proportion of male children in both cities is higher.The median age of diagnosed children in Xi'an was 7.0 years(IQR:1.0-13.0 years old),and the age range was 4 d-18 years old,while the median age of Baoji children was 9.0 years old(IQR:5.0-17.0 years old),ranging from 3 months to 18 years old.The number of children vaccinated in Xi'an and Baoji was positively correlated with the number of infected children.The vaccination rates of children in Xi'an and Baoji were 64.06%and 52.73%,respectively.The vaccination rates of infants(≤1 year old)in both cities were 18.52%and 14.29%,respectively.On the whole,the number of new child cases in the two cities increased first and then decreased.The peak number of new child cases in Xi'an was 39(10th day of statistics),while that of Baoji was 13(6th day of statistics).The peak in Xi'an comes later and the epidemic lasts longer.Among the children in Xi'an,201(71.53%)had a history of close contact,55(19.57%)had no clear history of COVID-19 infection,and were positive after actively participating in the nucleic acid test of all members of the community,of which 54(98.18%)were primary and middle school students.54 cases(98.18%)of Baoji children had a history of close contact,of which 20 cases were infected by the confirmed case number 62 officially announced on March 10.The time to be positive for viral nucleic acid test in children after isolation was 1-14 days.The positive rate of children in Xi'an reached 85.41%(240/281)after 7 days of isolation,and the highest peak of positive detection was on the third day of isolation(84 cases).After 7 days of isolation,45 cases were positive in Baoji,accounting for 81.82%(45/55).The highest peak of positive detection was on the 5th day of isolation(11 cases).The regional distribution of infected children in Xi'an was the highest in Yanta District(137 cases),followed by High-tech Zone(42 cases)and Lianhu District(29 cases).The main manifestations of COVID-19 in Xi'an were light(278 cases,98.93%),common type(3 cases,1.07%),light in Baoji(54 cases,98.18%),and common type(1 case,1.82%).Through general clinical treatment(including traditional Chinese medicine treatment and symptomatic treatment),all were cured.Conclusion:Delta variant increases the susceptibility of children to infection,which spreads rapidly mainly through close family contact and community concealment,so it is necessary to study better early diagnosis and prevention and control measures.

Kāiqiàotōngluòacupuncture combined with repetitive transcranial magnetic stimulation for the treatment of hand dysfunction after stroke

Objective:To observe the clinical improvement of Kāiqiàotōngluò(induce resuscitation and remove obstruction in meridians)acupuncture combined with repetitive transcranial magnetic stimulation(rTMS)in patients with hand dysfunction after stroke,and to provide evidence for its extensive application in the future.Methods:Sixty patients with the problem of hand dysfunction were divided into the observation group and the control group randomly.The two groups of patients were treated with the basic treatment,the observation group received Kdiqiaotongluo acupuncture combined with rTMS,and the control group only received the rTMS treatment.Broetz hand function scale,hemiplegic hand function grading,and modified Barthel index were used to evaluate the hand function of the patients in two groups before and after treatment.Results:After treatment,Broetz score of the patients in observation group and control group were significantly lower than that before treatment,and Broetz score of the patients in observation group was lower than that of control group(all P<0.05);As for the hemiplegic hand function grading,24 cases in the observation group improved,the improvement rate was 80.0%,and 8 cases in the control group improved,the improvement rate was only 26.7%.The improvement rate of observation group was significantly better than that of control group(P<0.01);the Barthel index scores of the observation group and the control group were significantly improved after treatment,and the observation group was better than the control group(both P<0.05).Conclusion:The Kāiqiàotōngluòacupuncture combined with rTMS can improve the hand dysfunction of patients after stroke,and it is worthy of clinical application.

Disturbance effects on community structure of Ficus tinctoria fig wasps in Xishuangbanna, China： Implications for the fig/fig wasp mutualism

Fig trees are important components of tropical forests, because their fruits are eaten by so many vertebrates, but they depend on pollinating fig wasps to produce mature fruits. Disturbance to habitat structure can have a major impact on insect diversity and com- position, potentially reducing fruit yields. We investigated the impact of habitat disturbance on the fig wasp community associated with male figs ofFicus tinctoria in Xishuangbanna, China. The community comprised one pollinator species Liporrhopalum gibbosae and six non-pollinating wasp species： Sycoscapter sp. 1, Philotrypesis ravii, Philotrypesis sp. 1, Neosycophila omeomorpha, Sycophila sp.1, and Walkerella sp.1. More disturbed areas were characterized by higher temperatures, less shade, and more vehicle noise. The response of the fig wasp community was complex, with no simple relationship between intensity of disturbance and pollinator abundance. However, the sex ratios （proportion of male progeny） of pollinators increased significantly in more disturbed areas. We conclude that potential changes in fig wasp community composition brought about by disturbance, are unpredictable, with unclear consequences for tropical rainforest biodiversity.