Objective To evaluate the performace of fixed field Intensity modulated radiation therapy (IMRT) and RapidArc in the radiotherapy for multiple intracranial metastases.Methods The clinical data of 10 patients with multiple intracranial metastases,8 male and 2 female,aged 65-73,were used to design 3 plans:fixed field IMRT,RapidArc with single Arc (RA1),and RapidArc with double Arc (Arc 2).Dose-volume-histogram analysis was used to compare dose results,monitor unit,and delivery time.Results All 3 plans met the clinical requirements.The best target conformity and homogeneity were observed in the RA2 plan (Z = -2.803,- 2.904,P ＜ 0.05) and there were no statistical differences between the IMRT plan and RA1 plan.The maximum doses to the lens,eyes,and brainstem of the two RapidArc plans were all significantly lower than those of the IMRT plan(Z = -2.803--2.191 ,P ＜0.05),and the maximum dose to the optic nerves of the RA2 plan was significantly lower than that of the IMRT plan (Z = -2.293,-2.701 ,P ＜0.05).Compared with the IMRT plan,the average monitor units of the RA1 and RA2 plans were reduced by 29% and 24%,respectively,and the delivery time of these plans were significantly shorter by 84% and 69%,respectively.Conclusions Compared to the IMRT plan,RapidArc plans with single or double Arcs show similar or better effects in the target dose distribution,reduction of irradiation doses on organs at risk and,moreover,significant decrease of the monitor units and delivery time.

Objective To study the impact of setup error caused by computed tomography ( CT) images with different resolutions in the Sentinel system on clinical treatment. Methods A phantom was scanned by large?aperture positioning CT with two different resolutions ( CT1:0. 5 mm × 0. 5 mm × 1. 0 mm, FOV 256 mm, Matrix 512, thickness 1 mm;CT3:1. 0 mm×1. 0 mm×3. 0 mm, FOV 500 mm, Matrix 512, thickness 3 mm) . The CT images were transferred to the planning system. The radiation fields were designed and transferred to MOSAIQ and Sentinel systems. Ten fixed setup errors were applied to a six degree of freedom couch. The Sentinel system was used to position the two groups of CT images and generate the setup errors. The comparison of two datasets was made by paired t?test. Cone?beam CT was used for independent verification. Results The setup errors in x?, y?, and z?directions were significantly smaller on CT1 than on CT3(0.19±0. 11 vs. 0.33±0. 16 mm, P=0. 061;0.59±0. 79 vs. 1.07±1. 09 mm, P=0. 008;0.67±0. 75 vs. 1.16±1. 30 mm, P=0. 043). There were no significant differences in rotational errors in x?, y?, or z?directions between the two datasets ( P=0. 494;P=0. 182;P=0. 298) . Conclusions The Sentinel system has a higher setup accuracy in the 0. 5 mm×0. 5 mm×1. 0 mm mode than in the 1. 0 mm×1. 0 mm×3. 0 mm mode. However, the later mode is still an acceptable choice in clinical treatment.

Objective To investigate the influence of acupuncture on learning and memorial function and the expression of BDNF in prefrontal cortex of rats with sleep deprivation (SD), for providing theoretical evidence for treating sleep deprivation with acupuncture.Method Sixty Wistar rats were randomly divided into a control group, a model group, and an acupuncture group, 20 rats in each group. SD models were established by the modified multiple platform methods; the acupuncture group was intervened by acupuncture at Shenmen (HT 7); while the control group was left intact. Respectively after SD for 24 h and 72 h, the learning and memorial function was tested by using Morris water maze. Ten the rats were sacrificed to collect brain for detecting the expression of BDNF in prefrontal cortex via immunohistochemical method.Result The body weight, learning and memorial function, and the expression of BDNF in prefrontal cortex of the acupuncture group and model group were significantly different from those of the control group after SD for 24 h and 72 h (P<0.05). The learning and memorial function of the acupuncture group was significantly different from that of the model group after SD for 24 h and 72 h (P<0.05). The body weight and expression of BDNF in prefrontal cortex of the acupuncture group were significantly different from those of the model group after SD for 72 h (P<0.05).Conclusion Acupuncture can obviously improve the decline of the function of learning and memory of the SD rats, and also up-regulate the declined expression of BDNF in prefrontal cortex caused by SD.

Objective To explore the influencing factors for postoperative adjuvant chemotherapy effects in elderly patients with breast cancer. Methods Five hundred and ninety female patients aged 65 years or older with invasive breast cancer were treated in our hospital, and the influencing factors for postoperative adjuvant chemotherapy effects were analyzed by chi-square test and logistic regression. Results Two hundred and thirty-one (39.2%) patients received postoperative adjuvant chemotherapy. The results showed that diabetes, age, patterns of operation and pathological characteristics of tumor had significant influences on postoperative adjuvant chemotherapy effects (χ2=4.49,88. 27,23.49 and 9.40, all P<0.05). Logistic regression analysis showed that age, tumor size, lymph node status(pN) and estrogen receptor (ER) status were related to postoperative adjuvant chemotherapy effects(χ2=68.857,15. 284,43. 540 and 7.009 ,all P<0.01). Forty-four patients (66.7%) with pN(+)/ER(-) received adjuvant chemotherapy. Conclusions Age, tumor size, lymph node status and ER status were independent predictive factors for postoperative adjuvant chemotherapy effects in elderly patients with breast cancer.

Objective:To learn about the employment situation of community-dwelling spinal cord injury (SCI ) survivors in Jiangsu Province and the factors which influence it, aiming to put forward suggestions which can help them return to work.Methods:This cross-sectional observational study was based on a International Spinal Cord Injury (InSCI) community survey in Jiangsu Province using a questionnaire (InSCI questionnaire) devloped with the International Classification of Functioning, Disability and Health as the framework. Data were collected using the InSCI questionnaire. Data on sociodemographics, diseases, body functions, activities and participation, environmental factors, general health, well-being and so on were collected. Descriptive statistics were computed to analyze the respondents′ employment-related information. Correlation analysis and multiple linear regression were used to analyze factors influencing the employment of these community-dwelling SCI survivors.Results:From January to December of 2018, 726 completed questionnaires were collected-541 through telephone interviews, 152 via Internet links and 33 via face-to-face interviews. Logistic regression showed that residential patterns (odds ratio, OR=0.472), whether there was someone to take care of them at home or going out ( OR=0.405), age at the onset of injury ( OR=0.949), personal factors ( OR=1.068), activity and participation ( OR=1.034), and environmental factors ( OR=1.043) all influenced the respondents′ engaging in paid work. Conclusion:The employment rate of patients with spinal cord injury living in the community is low (22.8%). Comprehensive rehabilitation programs and adequate family and social support should be implemented to help them return to work.

Objective To investigate the clinical characteristics of patients with acute myocardial infarction (AMI) complicated with cardiac rupture (CR) and to explore the risk factors for the survival time of AMI combined with CR. Methods A retrospective study was conducted. The clinical data of 75 hospitalized patients with the confirmed diagnosis of AMI combined with free wall rupture (FWR) or ventricular septal rupture (VSR) admitted to Guangdong General Hospital from April 2009 to March 2015 were collected. They were divided into a survival < 30-day group (42 cases) and a survival ≥ 30-day (33 cases) group, and their clinical characteristics were analyzed. Receiver operating characteristic curve (ROC curve) was drawn, and the predictive value of each indicator for the patient's 30-day survival time was analyzed. Results The number of female patients (25 cases vs. 0 case) and the number of patients without diabetes (36 cases vs. 21 cases) in the survival < 30-day group were significantly higher than those in survival ≥ 30-day group (all P < 0.05). Therefore, both female and without diabetes were risk factors for the recent death of AMI complicated with CR. In the survival ≥ 30-day group, the number of patients with right coronary artery (RCA) lesions and immediately undergoing early percutaneous coronary intervention therapy (PCI) was significantly higher than that in survival < 30-day group (11 cases vs. 4 cases, P < 0.05). Therefore, the RCA lesion and immediately undergoing early PCI therapy was a recent survival protective factor. ROC curve analysis showed that AMI female and combined with diabetes and lesions in RCA had a certain predictive value for survival time of the patients, the area under ROC curve (AUC) and 95% confidence interval (95%CI) were 0.798 (0.696-0.899), 0.592 (0.542-0.743) and 0.647 (0.500-0.794) respectively, sensitivity and specificity were 34.6%, 16.1% and 42.3% and 12.9% respectively, all P < 0.05. Conclusions Women and without diabetes are the risk factors of recent death of AMI complicated by CR, and in patients with AMI complicated with CR and the involved lesion being RCA, PCI therapy should be performed as early as possible that may elevate the 30-day survival rate for the patients.