The purpose of this paper is to introduce the advance of J.Carr and R. Shepherd's A Motor Relearning Programme for Stroke. In the neurosciences, it has been typical to consider the dyscontrol characteristics associated with the upper motor neuron syndrome as positive features and negative features for a long time. Recently Dr. Carr and Dr. Shepherd have proposed another group of characteristics which they call adaptive features, since it appears likely that adaptive changes to neural system, muscles and other soft tissues and adaptive motor behaviors underline some clinical signs. They point out that early rehabilitation and active life should be arranged for the stroke patient. It is the author's suggestion that we should pay more attention to the “disuse syndrome”in training of the stroke patient according to the adaptive features, and we should understand the “misuse syndrome” correctly and we should not neglect to train the muscle strength in correcting the patient's abnormal movement pattern, since the negative features are major reasons for functional disability, together with the adaptive changes that occur in soft tissues as a result of denervation, immobility and disuse.

Objective:To analyze the predictive effect of tumor deposit(TD) on the prognosis of yp-stage Ⅲ rectal cancer patients, and its effect on postoperative adjuvant chemotherapy benefit.Methods:Clinical data of 338 ypⅢ stage rectal cancer patients who received multidisciplinary treatment in Union Medical College Affiliated Hospital of Fujian Medical University from 2007 to 2017 were retrospectively analyzed. All patients were divided into the TD(-) group( n=301) and TD(+ ) group( n=37). Survival analysis was conducted by Kaplan- Meier method, log-rank test and univariate prognostic analysis. Multivariate prognostic analysis was performed by Cox’s regression model. Results:The 5-year overall survival(OS), progress-free survival(PFS), and distant metastasis-free survival(DMFS) in the TD(-) group were significantly higher than those in the TD(+ ) group(59.3% vs. 42.0%, P=0.001, 79.1% vs. 55.0%, P<0.001, 55.6% vs. 38.0%, P<0.001), whereas no significant difference was observed in local recurrence-free survival(LRFS) between two groups(96.7% vs. 85.5%, P=0.679). Univariate prognostic analysis revealed that the number of TD was not correlated with the prognosis of patients( P=0.923), and postoperative adjuvant chemotherapy exerted no significant effect on the prognosis of patients in two groups( P=0.103). In multivariate analysis, TD was associated with worse OS( HR=2.343, 95% CI: 1.257-4.363, P=0.007). Conclusions:For patients with ypⅢ stage rectal cancer undergoing multidisciplinary treatment, the prognosis of patients with TD is even worse. TD is an independent predictor for survival. No benefit can be obtained from postoperative adjuvant chemotherapy regardless of the presence or absence of TD.

Objective To study the effect factors and sensitive parameters in normal subjects with static posturography. Methods A computerized stabilometer was used to evaluate 588 normal subjects in the eyes closed condition. t test was used to analyze gender factors in every age group, canonical correlation analysis method to analyze the relative effect of age, body height and body mass factors and the static posturography parameter values. Results The parameter values between gender showed significant difference ( P

Objective To study the range of the reference value of static posturography parameters in normal subjects. Methods Six hundred and eleven normal subjects were recruited. Static standing balance test of these subjects was performed by use of a computerized stabilometer with their eyes opened and closed,respectively,when their feet standing close and apart. Ten parameters were obtained. 95% confidence ranges were calculated using normal distribution methods,which were grouped by sex and age. Results Statistically significant differences of the 95% confidence ranges of equilibrium parameters were found among different sex and age groups,feet positions and eyes conditions,respectively. The value of the parameters of the male was higher than that of the female;the value of the equilibrium parameters was the lowest in the age group of 15～19 years,and the highest in 66～79 age group;and there were no significant differences among 20～35,36～50 and 51～65 age groups. The value of various parameters in standing with feet close was higher than that with feet apart. It was higher with eyes closed than that with eyes opened. Conclusion Sex,age,feet position and visual input affect balance function.

A computerized stabilometer was used to evaluate the balance function of 31 subjects with healthy backs and 3l subjects with chronic low back pain. According to the difference of age and sex,they were divided into 2 groups equally. They were told that the feet stood side by side and stood separately with eyes opened and closed. The sensitivity and applying value of all of the test parameters were analyzed. The result showed that the stabilization of the subjects with chronic low back pain was poorer than the healthy subjects. The parameters, such as Sx, Sy, MS, PL, CA and AS, were sensitive, and feet stood side by side was more sensitive than feet stood separately.

Objective To investigate the discriminant analysis model of gray-scale ultrasound (GSUS),contrast-enhanced ultrasound (CEUS) and the combination of them in the differential diagnosis of benign and malignant thyroid lesions and the diagnostic values.Methods Ultrasound images of 211 thyroid lesions confirmed by pathology were synthetically reviewed by scoring 5 GSUS indicators including shape (X1),orientation (X2),interior echogenicity (X3),halo sign (X4),and microcalcification (X5),as well as 6 CEUS indicators including relative arrival time of microbubhles in the periphery (X6) and interior (X7),peak periphery (X8) and interior (X9)echogenicity,peripheral ring-enhancement (X10),homogeneity of enhancement (X11).The diagnostic models with their values of GSUS,CEUS and the combination of them were explored by discriminant analysis.Results The discriminant analysis function of GSUS in the diagnosis of thyroid benign and malignant lesions was g1 (X) =0.715 X1+0.276X2 + 1.028X3 +1.197X4 +0.923X5-2.202 with the diagnostic value 86.3％,the discriminant analysis function of CEUS was g2(X) =-0.392X6 +0.541X7-0.117X8 +0.562X9 + 1.173X10 +2.200X11-1.956 with the diagnostic value 89.1％,and the discriminant analysis function of the combination of GSUS and CEUS was g3 (X) =0.418X1 + 0.173X2 + 0.626X3 + 0.558X4 + 0.183X5-0.476X6 + 0.474X7-0.071X8 + 0.399X9 + 0.985X10 +1.639X11-2.530 with the diagnostic value 91.0％.Conclusions GSUS and CEUS were valuable in the differential diagnosis of benign and malignant thyroid lesions,and the combination of GSUS and CEUS was most valuable.

Objective To evaluate the value of quantitative analysis of real-time elastosonography in the differential diagnosis of benign and malignant thyroid nodules. Methods The elastograms of eight-six patients with 98 thyroid nodules were observed. The strain ratio of each lesion and the averages of those of benignancy and malignancy were calculated. With the ROC curve, the critical point of the strain ratio of different lesions was gotten. All the lesions were confirmed with surgery and pathologic examination. Results The average of strain ratio of benign nodules was 2. 18,while that of malignancy was 8. 48. The strain ratio of benign and malignant lesions were of significant difference statistically (P <0.05). According to ROC curve, the critical point of strain ratio between benign and malignant lesions was 3. 3. Conclusions The quantitative analysis of real-time elastosonography is a newly valuable technique of ultrasonography which is helpful in the differential diagnosis of thyroid lesions.

Objective To investigate the dosimetric performance of two algorithms for correcting the presence of tissue inhomogeneities,the finite site pencil beam (FSPB) and X-ray voxel Monte Carlo (XVMC) plans were implemented in the MONACO system,with the accuracy of application to clinic treatment of two algorithms were evaluated.Methods In a non-uniform artificial anthropomorphic phantom,regular open fields and intensity modulation radiated therapy (IMRT) plans of the MONACO were measured by using calibrated EBT2 films,and the dose accuracy of the two kinds of plans was analyzed by comparing the planned and measured plane dose.Results In an anthropomorphic phantom,the deviations between the calculated values by XVMC and the measured values by films were less than ± 2％.While the deviations of FSPB values between calculation and measurements was within ± 3％,except at the condition of 15 MV,10 cm ×2 cm field,the dose error in lung was up to 6.51％.The verification of individual IMRT beams based on films showed that the pass rates of calculation by XVMC and FSPB were larger than 90％ with γ criterion of 3％/3 mm and 4％/4 mm,respectively.At 3％/3 mm,the pass rates of FSPB were in the range of 80％-90％.At the same time,the pass rates of all individual fields were higher than 90％.Conclusions The accuracy of dose calculation of XVMC is better than that of FSPB when being in multi-segments and non-uniform media.The error of algorithm can be controlled within ±3％,for the calculation by XVMC.And the dose deficiency of PTV arising from algorithm can be avoided.

Objective To evaluate the potential influencing factors associated with pathologic complete response ( pCR) after neoadjuvant chemoradiotherapy for locally advanced rectal cancer ( LARC) . Methods A retrospective analysis was performed on the clinical data 265 patients with stageⅡandⅢ( the 7th version of AJCC) rectal cancer admitted to our hospital from 2011 to 2013. All patients underwent neoadjuvant concurrent chemoradiotherapy ( CCRT ) followed by surgery with/or without induction chemotherapy during the interval between the complete of CCRT and surgery. The predictors associated with pCR were analyzed by univariate and multivariate logistic regression analyses. With the use of the independent predictive variables for pCR from multivariate analysis, a clinical risk score model was established according to the following criteria:no?risk group (0 factor);low?risk group (1 factor);high?risk group ( 2 factors) . Results Among these 265 patients, 50( 18. 9%) achieved pCR. The univariate analysis showed that carcinoembryonic antigen ( CEA) level before CCRT ( P=0. 017) , T stage before CCRT ( P=0. 001), interval between complete of CCRT and surgery (P=0. 000), and the maximum tumor thickness before CCRT ( P=0. 040) were significantly associated with pCR. The multivariate analysis showed that pre?CCRT CEA level ( P=0. 021 or 0. 446) and interval between the complete of CCRT and surgery ( P=0. 000 or 3. 774) were significant predictors of pCR. When stratifying for smoking status, only low pre?CCRT CEA level was significantly associated with pCR in the non?smoking patients ( P=0. 044) . For the prediction of pCR by the clinical risk score model, the sensitivity was 0. 805, the specificity was 0. 460, the area under the receiver operating curve was 0. 690 ( 95% CI= 0. 613?0. 767 ) , the positive predictive value was 35 . 4 9%, the negative predictive value was 8 6 . 5%, and the predictive accuracy was 7 3 . 9%. Conclusions For locally advanced rectal cancer, pCR can be achieved in some patients after neoadjuvant therapy. Low pre?CCRT CEA level and long interval time between CCRT and surgery are independent factors associated with pCR, and only low pre?CCRT CEA level is an associated factor in the group of nonsmokers. The clinical risk score model based on pre?CCRT CEA level>5 ng/ml and time interval from CCRT completion to surgery≤8 weeks can be used to predict pCR after neoadjuvant chemoradiotherapy for LARC.

Objective To extract principal components from valuable indicators on conventional ultrasoundand contrast-enhanced ultrasound (CEUS) in the differential diagnosis of thyroid benign and malignant lesions and to discuss the diagnostic value of each indicator.Methods One hundred and three patients with 125 thyroid lesions (65 malignant lesions and 60 benign lesions) underwent preoperative grayscale ultrasound (GSUS),color Doppler ultrasound (CDUS) and CEUS examinations.Eighteen indicators were chosen to evaluate every lesion and principal components were extracted by principal component and valuable indicators were ordered by importance.Results There were significant differences on GSUS and CEUS indicators between benign and malignant lesions.The first principal component was the representation of contrast enhanced ultrasound and was valuable in the differential diagnosis of thyroid benign and malignant lesions.The rank of valuable CEUS indicators were homogeneity of enhancement,filling defect,relative arrival time of periphery,peak interior echogenicity,relative arrival time of interior,peak peripheral echogenicity and ring enhancement.Conclusions GSUS and CEUS are valuable in the differential diagnosis of thyroid benign and malignant lesions.