Tumor size before image-guided brachytherapy is an important factor of local control after radiotherapy for cervical squamous cell carcinoma: analysis in cases using central shielding

We analyzed the local control (LC) of cervical squamous cell carcinoma treated by computed tomography (CT)-based image-guided brachytherapy (IGBT) using central shielding (CS). We also examined the value of tumor diameter before brachytherapy (BT) as a factor of LC. In total, 97 patients were analyzed between April 2016 and March 2020. Whole-pelvic (WP) radiotherapy (RT) with CS was performed, and the total pelvic sidewall dose was 50 or 50.4 Gy; IGBT was delivered in 3–4 fractions. The total dose was calculated as the biologically equivalent dose in 2 Gy fractions, and distribution was modified manually by graphical optimization. The median follow-up period was 31.8 months (6.3–63.2 months). The 1- and 2-year LC rates were 89% and 87%, respectively. The hazard ratio was 10.11 (95% confidence interval: 1.48–68.99) for local recurrence in those with a horizontal tumor diameter ≥ 4 cm compared to those with < 4 cm before BT. In CT-based IGBT for squamous cell carcinoma, favorable LC can be obtained in patients with a tumor diameter < 4 cm before BT. However, if the tumor diameter is ≥ 4 cm, different treatment strategies such as employing interstitial-BT for dose escalation may be necessary.     

Effects of Early versus Standard Central Line Removal on the Growth of Preterm Infants with Very Low Birth Weight: A Non-Inferiority,Randomized Clinical Trial

Very preterm infants are usually supported by parenteral nutrition delivered through central lines (CLs) while progressing with enteral intake, although the optimal time point for their removal is unclear. This study evaluated the impact of the CL discontinuation time on the short-term growth outcomes of preterm infants. A non-inferiority, parallel-group, randomized controlled trial was conducted in four neonatal intensive care units in Poland. Preterm infants with very low birth weight (VLBW) without congenital abnormalities were eligible. Patients were allocated to discontinue central access at an enteral feeding volume of 100 mL/kg/day (intervention group) or 140 mL/kg/day (control group). The study’s primary outcome was weight at 36 weeks’ postmenstrual age, with a non-inferiority margin of −210 g. Overall, 211 patients were allocated to the intervention or control groups between January 2019 and February 2021, of which 101 and 100 were eligible for intention-to-treat analysis, respectively. The mean weight was 2232 g and 2200 g at 36 weeks’ postmenstrual age in the intervention and control groups, respectively. The mean between-group difference was 32 g (95% confidence interval, −68 to 132; p = 0.531), which did not cross the specified margin of non-inferiority. No intervention-related adverse events were observed. Early CL removal was non-inferior to the standard type for short-term growth outcomes in VLBW infants.     

Risk factors for 90-day all-cause mortality in post-operative central nervous system infections (PCNSIs): A retrospective study of 99 patients in China

Post-operative central nervous system infections (PCNSIs) are serious complications of craniotomy. Many factors, including patient-related, surgical, and postoperative factors, affect the survival of patients with PCNSIs. Timely and effective implementation of antibiotics targeting pathogenic bacteria is crucial to reduce mortality. Metagenomic next-generation sequencing (mNGS) has been used successfully to detect pathogens associated with infectious diseases. This study was designed to evaluate the factors influencing mortality and to explore the application value of mNGS in patients with PCNSIs. We conducted a retrospective study of patients with PCNSIs in our unit from 1/12/2019 to 28/2/2021. Clinical data, cerebrospinal fluid (CSF) parameters, surgical information, and mNGS results were collected. Follow-up telephone calls were made in June 2021 for 90 days survival after discharge. 99 patients were enrolled, and the overall mortality rate was 36.4% (36/99). Kaplan–Meier survival analysis suggested that the risk factors for poor prognosis included age ≥ 53 years, Glasgow Coma scale (GCS) score ≤ 8, CSF/blood glucose ratio (C/B-Glu) ≤ 0.23, 2 or more operations, mechanical ventilation (MV), and non-mNGS test. MV and poor wound healing were independent risk factors for 90 day mortality according to the multivariate Cox proportional hazards model (OR = 6.136, P = .017, OR = 2.260, P = .035, respectively). Among the enrolled patients, causative pathogens were identified in 37. Gram-negative pathogens were found in 22 (59.5%) patients, and the remaining 15 (40.5%) were Gram-positive pathogens. Univariate analysis showed that white cell count and protein and lactate levels in the CSF of the Gram-negative group were higher than those of the Gram-positive group (P < .05). mNGS and conventional microbiological culture were tested in 34 patients, and the positive detection rate of mNGS was 52.9%, which was significantly higher than that of microbiological culture (52.9% vs 26.5%, χ² = 4.54, P = .033). The mortality rate of PCNSIs is high, and patients with MV and poor wound healing have a higher mortality risk. Gram-negative pathogens were the predominant pathogens in the patients with PCNSIs. mNGS testing has higher sensitivity and has the potential to reduce the risk of mortality in patients with PCNSIs.     

慢性淋巴细胞白血病伴中枢神经系统浸润1例并文献复习

    目的   探讨慢性淋巴细胞白血病（chronic lymphocytic leukemia,CLL）伴中枢神经系统（central nervous system,CNS）浸润的发病率、诊治方法及预后。    方法   报道1例以头晕、复视、肢体无力为首发表现的CLL患者诊治经过并结合文献复习。    结果   尸解研究显示CLL浸润CNS的发生率为8%~71%,而患者生前出现有症状CNS浸润的发生率较低约1%,发生原因与临床分期、年龄、性别及疾病变异无明确相关性,临床表现不特异,诊断主要依靠脑脊液细胞形态学结合流式细胞分析,鞘内化疗及放疗可使多数患者CNS症状及脑脊液改善,未治疗的患者均迅速恶化死亡。    结论   CLL有症状的CNS浸润较少见,一旦发生预后差,及时诊断和积极治疗是获得长期缓解的关键。     

昆明市官渡区肥胖相关糖尿病经济负担分析

目的 了解云南省昆明市官渡区农村居民归因于肥胖和中心性肥胖的糖尿病经济负担。方法 采用按比例概率抽样方法(PPS)从昆明市官渡区居民中随机抽取4 595名≥18岁的农村居民进行现场问卷调查和体格检查。结果 昆明市官渡区农村居民糖尿病患病率为6.2%(男性为5.6%,女性为6.8%),肥胖率为11.2%(男性为8.9%,女性为13.3%),中心性肥胖率为52.8%(男性为46.6%,女性为57.9%);男性的肥胖率和中心性肥胖率均低于女性(P<0.05);糖尿病的总直接疾病经济负担为100.49百万元,其中5.60%归因于肥胖(5.62百万元),15.71%归因于中心性肥胖(15.79百万元);肥胖(OR=1.435)、中心性肥胖(OR=1.342)、年龄(OR=1.019)、吃甜食(OR=0.275)为患糖尿病的危险因素。结论 糖尿病给当地造成了沉重的经济负担;减少肥胖和中心性肥胖的发生,有助于减少糖尿病的发生,从而降低其经济负担。     

星形胶质细胞的电离辐射损伤及修复作用

星形胶质细胞(astrocyte, Ast)是中枢神经系统内最多的胶质细胞。体内外实验结果表明,电离辐射作用于神经系统后,可引起神经元、胶质细胞和血管内皮细胞等多种细胞的形态和功能变化。照射后早期Ast即可发生反应,与脑组织损伤后的病理过程及损伤后修复有着密切的联系。研究Ast在辐射损伤中的作用对于临床放射性脑损伤的治疗有着重要的意义。     

酶处理急性分离技术用于研究果蝇成虫中枢神经细胞钾电流

目的 建立急性分离果蝇成虫中枢神经细胞技术,并记录分析其钾电流。方法 取S、R或H品系果蝇成虫3—5只,分离出果蝇脑组织。胶原酶消化处理后,加入10％的胎牛血清果蝇培养基终止酶反应。巴氏吸管吹打,细胞悬液静置1h后用于电生理实验。全细胞电压钳记录并分析其外向钾电流。结果 酶消化法成功急性分离出果蝇成虫中枢神经细胞。85％以上为Ⅱ型神经细胞,少部分为Ⅰ型和Ⅲ型神经细胞。记录到快失活与持续复合型、慢失活型、快失活和持续型四种全细胞钾电流。结论 本技术可成功急性分离三品系果蝇成虫中枢神经细胞,并记录到四种钾电流。     

中国全科医生培养发展报告(2018)

  目的  了解中国东中西部地区全科医生的离职意愿现状及其影响因素,为稳定全科医生队伍、提升全科医生职业吸引力以及提高基层医疗卫生服务质量提供理论依据和政策建议。  方法  于2017年10月 — 2018年2月采用多阶段分层随机抽样方法在中国东中西部地区12个省/市/自治区360个社区卫生服务机构抽取3244名全科医生进行微信问卷调查。  结果  中国东中西部地区全科医生离职意愿总分为（15.07 ± 4.33）分,其中东部地区（15.11 ± 4.10）分,中部地区（15.26 ± 4.52）分,西部地区（14.83 ± 4.40）分。中国东中西部地区调查的3236名全科医生中,离职意愿很高者667人（20.61 %）,较高者1633人（50.46 %）,较低者728人（22.50 %）,很低者208人（6.43 %）。多元线性逐步回归分析结果显示,本科及以上文化程度、任职方式为合同制、工作压力较高、情绪耗竭得分较高、去人格化得分较高和个人成就感得分较高的中国东中西部地区全科医生离职意愿较高,女性、年龄较大、无行政职务、物质满意度得分较高和成长满意度得分较高的中国东中西部地区全科医生离职意愿较低;情绪耗竭得分较高的中国东部地区全科医生离职意愿较高,年龄较大、无行政职务、个人年均收入 ≥ 5万元、物质满意度得分较高和成长满意度得分较高的中国东部地区全科医生离职意愿较低;本科文化程度、任职方式为合同制、情绪耗竭得分较高、去人格化得分较高和个人成就感得分较高的中国中部地区全科医生离职意愿较高,物质满意度得分较高和成长满意度得分较高的中国中部地区全科医生离职意愿较低;本科及以上文化程度、任职方式为合同制、工作压力较高和情绪耗竭得分较高的中国西部地区全科医生离职意愿较高,女性、年龄较大、物质满意度得分较高和成长满意度得分较高的中国西部地区全科医生离职意愿较低。  结论  中国东中西部地区全科医生的离职意愿较高,性别、年龄、文化程度、任职方式、行政职务、工作压力以及物质满意度、成长满意度、情绪耗竭、去人格化和个人成就感得分是中国东中西部地区全科医生离职意愿的主要影响因素,不同地区的影响因素不同。     

中老年人群中心性肥胖与多种慢性病的关联分析

  目的  了解江苏省中老年居民中心性肥胖与慢性阻塞性肺疾病（简称“慢阻肺”）患病的关系,为慢阻肺高危人群的早期发现及制定慢阻肺防控策略和措施提供参考依据。  方法  于2015年7 — 12月采用多阶段整群随机抽样方法在江苏省南京市雨花台区、江阴市、溧阳市、连云港市海州区、淮安市淮安区和扬中市6个监测点抽取3600名 ≥ 40岁中老年居民进行问卷调查、体格检查和肺功能检测。  结果  江苏省3365名 ≥ 40岁中老年居民中,中心性肥胖者1545人（45.9 %）,非中心性肥胖者1 820人（54.1 %）;患慢阻肺者428例,慢阻肺患病率为12.7 %。在调整了性别、年龄、文化程度、职业、吸烟情况、二手烟暴露史、烹饪燃料暴露史、烹饪油烟暴露史、取暖燃料暴露史、职业粉尘或有害气体暴露史、体质指数和是否高血压等混杂因素后,多因素非条件logistic回归分析结果显示,江苏省中心性肥胖的中老年居民慢阻肺患病风险为非中心性肥胖中老年居民的1.41倍（OR = 1.41,95 % CI = 1.05～1.89）。分层分析结果显示,女性、≥ 60岁、小学及以下文化程度、职业为农林牧渔者、无取暖燃料暴露史、有职业粉尘或有害气体暴露史和非高血压的中心性肥胖中老年居民慢阻肺患病风险较高（均P < 0.05）。  结论  江苏省有中心性肥胖的中老年居民慢阻肺患病风险较高。