Objective:To investigate the effect of body mass index (BMI) on setup errors in intensity-modulated radiotherapy for cervical cancer and explore the optimal position for patients with different BMI without taking into account the rotation error and the changes in target area and adjacent organs.Methods:A total of 90 patients were divided into three groups according to their BMI: light weight group (BMI≤18.4 kg/m 2), normal weight group (18.5 kg/m 2≤BMI≤23.9 kg/m 2) and overweight group (BMI≥24 kg/m 2). Thirty patients were assigned into each group including15 patients in the supine position and 15 patients in the prone position. In total, 2 250 sets of CBCT scan data of 90 patients were obtained. The setup errors were recorded and analyzed in each group. The margins of the optimal position were calculated according to the formula of M PTV=2.5+ 0.7. Results:When BMI was not taken into account, there was no significant difference in the setup errors between the supine and prone positions in the x, y and z directions (all P>0.05). When BMI was considered, the setup error in the supine position were significantly smaller than those in the prone position in the x and y directions in the light weight group, whereas there was no significant difference in the setup errors between the supine and prone positions in the z direction ( P>0.05). The corresponding M PTV in the supine position was 4.76, 4.27 and 5.73 mm, respectively. In the normal weight group, there was no significant difference in the setup errors between the supine and prone positions in the x and y directions (both P>0.05), whereas the setup error in the prone position was smaller than that in the supine position in the z direction. The corresponding M PTV in the prone position were 6.42, 10.21 and 4.91 mm, respectively. In the overweight group, there was no significant difference in the setup errors between the supine and prone positions in the x and z directions (all P>0.05), whereas the setup error in the prone position was smaller than that in the supine position in the y direction. The corresponding M PTV in the prone position were 5.88, 5.26 and 5.32 mm, respectively. Conclusions:Without taking into account the rotation error and the changes in target area and adjacent organs, when the BMI≤18.4, the supine position is recommended. When the BMI≥18.5, it is better to choose the prone position.

Objective To investigate the positioning errors of head and neck during intensity-modulated radiation therapy of nasopharyngeal carcinoma.Methods Nineteen patients with middle-advanced nasopharyngeal carcinoma (T2-4N1-3M0), treated by intensity-modulated radiation therapy, underwent repeated CT during their 6-week treatment course.All the patients were immobilized by head-neck-shoulder thermoplastic mask.We evaluated their anatomic landmark coordinated in a total of 66 repeated CT data sets and respective x, y, z shifts relative to their position in the planning CT.ResultsThe positioning error of the neck was 2.44 mm±2.24 mm,2.05 mm±1.42 mm,1.83 mm±1.53 mm in x, y, z respectively.And that of the head was 1.05 mm±0.87 mm,1.23 mm±1.05 mm,1.17 mm±1.55 mm respectively.The positioning error between neck and head have respectively statistical difference (t=-6.58,-5.28,-3.42,P=0.000,0.000,0.001).The system error of the neck was 2.33,1.67 and 1.56 higher than that of the head, respectively in left-right, vertical and head-foot directions;and the random error of neck was 2.57,1.34 and 0.99 higher than that of head respectively.Conclusions In the process of the intensity-modulated radiation therapy of nasopharyngeal carcinoma, with the immobilization by head-neck-shoulder thermoplastic mask, the positioning error of neck is higher than that of head.

Objective: To investigate the in vitro and in vivo inhibitory effects of DC (dendritic cell)-CIK (cytokine-induced killer cell) co-cultured cells combined with sorafenib against hepatocellular carcinoma cell line BEL-7402. Methods: DC and CIK cells were generated in vitro by stimulating human peripheral blood mononuclear cells with different cytokines, and then they were co-cultured. The cytotoxicity of DC-CIK co-cultured cells (DC-CIK) combined with sorafenib against BEL-7402 cells was determined by CCK8 kit. The apoptosis of BEL-7402 cells was measured by Annexin V-FITC Kit. BEL-7402-implanted tumor model was established by subcutaneous injection in nude mouse. Tumor-bearing mice were divided into normal saline control group, sorafenib group, DC-CIK group and DC-CIK+sorafenib group. The inhibitory effects were observed in different groups. Results: The cytotoxicity rate of BEL-7402 cells in DC-CIK+sorafenib group was significantly higher than those in the other two groups, with cytotoxicity rate in DC-CIK+sorafenib group being (75.24±1.91)%, which was 1.8 times that in DC-CIK group and 2.1 times that in sorafenib group (P<0.01). The apoptosis rate of BEL-7402 cells in DC-CIK+sorafenib group was significantly higher than those in the sorafenib and DC-CIK groups, with the apoptosis rate in DC-CIK+sorafenib group being (78.32±2.54)% (P<0.05). The volume of tumor in the combination group was significantly smaller than those in the other groups (P<0.05). In vivo results showed that DC-CIK+sorafenib treatment significantly inhibited the growth of BEL-7402-implanted tumors, and the inhibitory rate was (83.37 ±0.16)%, which was significantly higher than those of the other groups (P<0.01). Conclusion:DC-CIK co-cultured cells combined with sorafenib can inhibit the growth of hepatocellular carcinoma cell line BEL-7402 in vitro and in vivo. Molecular targeting therapy combined with immunotherapy may be a new way for the comprehensive treatment of hepatocellular carcinoma.

Objective To evaluate the clinical efficacy of Qilinxintongshu pill for treatment of critical patients with unstable angina pectoris (UAP) accompanied by upper alimentary tract damage.Methods A prospective randomized controlled trial was conducted. A total of 60 critical outpatients or inpatients with confirmed diagnosis of UAP accompanied by upper alimentary tract damage in Cardiology Department of Hospital of Traditional Chinese Medicine of Qionghai City from November 2011 to January 2015 were enrolled in the study, and they were assigned to a therapy group (30 cases) and a control group (30 cases) by table of random number. The conventional medical basic therapy was given to both groups, in addition, the patients in therapy group took Qilinxintongshu pill (made of notoginseng, dragon's blood, fruit of immature citron, etc.) 5 g once, three times a day, and the patients in control group orally administered clopidogrel 75 mg once a day, the therapeutic course being consecutive 30 days. After treatment, the rates of main cardiovascular events [including death, a newly-happened myocardial infarction (MI), and obstinate ischemia] and events of alimentary damage were compared between the two groups, and adverse effects were observed.Results There was no statistically significant difference in incidence of cardiovascular events between the therapy group and control group [6.7% (2/30) vs. 16.7% (5/30),P > 0.05]. The incidence of massive hemorrhage of gastrointestinal tract was significantly lower in therapy group than that in control group [10.0% (3/30) vs. 36.7% (11/30),P < 0.05]. In the treatment process, there was no significant untoward side effect, and no abnormalities in routine blood and urine tests, liver and renal functions were found.Conclusion Qilinxintongshu pill for treatment of critical patients with UAP accompanied by upper alimentary damage is safe and effective, and does not enhance the incidence of massive hemorrhage of gastrointestinal tract.

Objective:Before the radiotherapy was performed, patients with pelvic tumors were analyzed for the consistency of bladder filling in the three steps of " Immobilization" , " CT Simulation" and " X-ray Simulation" .Methods:In 2014, 105 patients (68 cases of cervical cancer, 32 cases of rectal cancer, 3 cases of vaginal cancer and 2 cases of prostate cancer) with pelvic tumor radiotherapy were randomly assigned to monitor bladder urine volume to a target urine volume of 400 ml. First, patient were exhorted to empty the bladder, and the bladder volume meter BVI 9400 was used to measure the urine volume of the patient after emptying of the bladder. The patient immediately drank about 540 ml of water and suppressed urine, measurements were taken every 0.5 h. At the same time, when the patient complained of " urgency of urine" , bladder urine volume would be measured again and the time would also be recorded. Every other half an hour (emptying, 0.5 h after emptying, 1.0 h after emptying), when complaining of " urgency of urine" , when actually performing urine volume and time were described as: U 0 and t 0, U 0.5 and t 0.5, U 1.0 and t 1.0, U t and t, U T and T. Results:There was a statistically significant difference in gender and age, and women had stronger ability to urinate than men U 1.0( P=0.003), young people had stronger ability to urinate than middle-aged U 1.0( P=0.002). In the three-step comparison, there was no statistically difference between 1 hour after emptying urine volume U 1.0( P=0.177) and the actually performing urine volume U T ( P=0.052). And the final urine volume was concentrated at 298-526 ml. After the patient emptied the urine volume and complained of " urgency of urine" , the time slot was t=(75.2±49.9) min, with the urine volume of U t=(331.2±140.3) ml. And there was no statistically difference between U t and U T ( P=0.198) at X-ray Simulation. Conclusions:The patient emptied the bladder and immediately drank 540 ml of water. After 1 hour of suppressing urine, he complained of " urgency of urine" and achieved the target urine volume (400 ml). At this time, the bladder urine volume U 1.0 was consistency in the immobilization, CT Simulation, and X-ray Simulation.

Objective To compare curative effect of decompression and conservative treatment for traumatic superior orbital fissure syndrome to discuss the operation indications and the operative oppor-tunity for this syndrome. Methods Data of 12 patients (seven males and five females) with 14 sides were compared to evaluate different curative effect between decompression and conservative treatment so as to optimize the initial corresponding treatment. Results The patients were at mean age of 28 years and followed up for mean six months. All patients were complicated by one and more of following symptoms in-cluding ophthalmoplegia, ptosis, proptosis and anaesthesia in the distribution of V1 and a fixed dilated pupil. There was one patient complicated by orbital apex syndrome. CT showed involvement of the superi-or orbital fissure in seven patients. Of seven patients treated with decompression, six got recovery at dif-ferent degrees. Meanwhile, three out of five patients treated with conservative treatment recovered to some extent. Conclusions Early effective treatment can improve the functional rehabilitation of the injured nerve. Decompression of superior orbital fissure is proved to be effective in ameliorating symptome, re-ducing disability and improving quality of life.

Objective To discuss clinical effects of early (<48 hours after injury) fraeture exter-nal fixation in treatment of severe traumatic brain injury (TBI) combined with extremity fracture. Meth-ods The study involved patients with no statistical difference in aspects of age, sex, GCS, fracture ,distri-bution and general condition. According to different treatment methods at early stage (<48 hours), the pa-tients with TBI were divided into Group A (early extremity fracture external fixation) and Group B (early extremity fracture traction or cast immobilization). A comparative observation was done on complications in-cluding bedsore, pneumonia and deep venous thrombosis and on duration in ICU, hospitalization, time for fracture healing and mortality in two groups. Results Incidence rate of bedsore, pneumonia, deep ve-nous thrombosis and mortality in Group A was lower than that in Group B (P<0.05), and Group A had shorter time for ICU, hospitalization and fracture healing (P < 0.05). Conclusion For patients with se-vere TBI combined with extremity fracture, early fracture external fixation is more effective to reduce com-plications, shorten the recovery time and reduce mortality, compared with conservative methods.

Objective To investigate and analyze clinical obstetrics and gynecology clinicians' mastery of basic skills, and then find the way to help clinicians master basic clinical skills. Methods A self-designed questionnaire survey was conducted among 310 clinicians working in 1-3 grade hospital from Chongqing, Sichuan, Guizhou, Yunnan provinces anonymously by spot field investigation and letter-investigations from February 1, 2015 and to March 31, 2015. The data were analyzed by descriptive analysis, using SPSS 19.0 software package for rank sum test analysis. Result Among 310 valid questionnaires, 31.6% (98) clinicians considered having inadequate clinical skills, 26% (81) average and 42.3%(131) expert. All the basic skills obtained had a relationship with the number of operations, working years and professional title. Most of the basic clinical skills were from working in hospitals 85% (270), journal 82% (254), academic conference 58% (174); 94.2% (293) willing to participate in training classes like clinical teaching and training in moulds. Conclusion The gynecology and obstet-rics basic clinical skills have a great relationship with basic skills training. Providing opportunities for the basic clinical skill trainings, academic conferences, in-service education and establishing regional medical source sharing platform can enhance their clinical skills.

Objective To investigate the biological effects of Wnt gene in kidney cancer Caki?2 cells. Methods The Wnt gene was silenced in kidney cancer Caki?2 cells by lentivirus vector. The cell proliferate ability of cells in each group were assayed by CCK?8 kit at different time points. The apoptosis of Caki?2 cells was observed after silencing Wnt gene by transmission electron microscope. The invasion ability of each group cells was tested using Transwell chambers. The genes expression changes of Wnt/β?catenin signaling pathway and apoptosis related gene were determined by realtime PCR. Results Compared with the other two groups,the cell proliferate ability of the cells after silencing Wntgene was suppressed,and the difference was statistically significant(P<0.05). Apoptosis increased significantly in shRNA+Caki?2+Wnt group cells with silencing of Wntgene, and apoptotic body appeared in these cells. In invasive experiment,the number of emigrated cells in shRNA+Caki?2+Wnt group were significantly lower than other groups(P<0.05). The expression of Wnt mRNA,β?catenin mRNA and Bcl?2 mRNA in shRNA+Caki?2+Wnt group cells was lower than other groups(P<0.05). Conclusion Silencing of Wnt gene of kidney cancer Caki?2 cells can affect the proliferation rate of the cells, promote the cell apoptosis,and inhibit the invasion ability,which provide certain theoretical basis for the research and development of new drugs and new therapeutic targets.

Objietive Observe the clinical curative effect of PPH in treatment of complexity hemorrhoids and circular hemorrhoid. Methods From January 2010 to January 2014, the clinical data of 278 patients who underwent PPH to treat complexity hemorrhoids, mixed hemorrhoid and circular hemorrhoid were retrospectively analyzed. The postoperative recent and forward curative effect was observed. Results The average operativetime was 28 minutes, and the average hospital stay were 6. 1 days. There were postoperative complications such as pain, anal skin edema, bleeding and urinary retention. 186 cases were cured (66. 9%),35 cases were markedly improved (12. 6%),20 ca-ses were of poor effect (7. 2%),and recurrence occured in 37 cases (13. 3%). Conclusion PPH has the advantages of simple in operation and quick in postoperative recovery. But there were to many postoperative complications and the recurrence rate is high. So PPH needs more further observation and study.