With the rapid development of intensity modulated radiation therapy (IMRT) technique,the accuracy of radiotherapy has improved,while the pretreatment dose verification has become more complex.Although the experimental measurements,a widely used way to perform dose verification,is accurate and effective,its time-consuming and labor-intensive is still a challenge for physicist.The independent dose verification method such as the depth dose-off axis ratios (OAR) empirical model,Clarkson integral model,convolution model and Monte Carlo model,could partially solve these problems effectively when the accuracy is ensured within a certain range.This approach could save physicists' time to conduct dose recalculation and plan check,and has become the hotspot in the world.This paper,therefore,mainly introduces the correction-based and the model-based independent dose verification methods,and briefly discusses the development of dose verification for IMRT plans.

Objective To study the effect of mild hypothermia on aquaporin 4 (AQP4) expressions and cerebral edema after intracerebral hemorrhage and the mechanisms of mild hypothermia on hemorrhagic brain edema. Methods The model of intracerebral hemorrhage (ICH) was established by infusing collagenase into right globus pallidus of the rat. The temperature was regulated by ice cubes and daylight lamp, which was modulated to an appropriate distance to the animals. Immunohistochemistry staining was used to detect the cerebral AQP4 expressions. Dynamic change of brain edema was observed through wet-dry weighing method. Results The brain water content (BWC) of injured side and level of AQP4 expression in perihematom tissue in ICH rats were obviously higher than those of the sham group (all P

[Objective]To investigate the cause precautionary measures and treatment countermeasure of impingement syndrome of the anterior ankle.[Method]From june 2000 to December 2004,18 cases of acute raumatic extravasated blood of the ankle without fracture and disbocating,20 cases of pain in front side and front inboard and front outside with dorsiflexion ache and dysfunction,all the cases were examined and treated under the arthroscope.The effect was analyzed.[Result]Follow-up lasted 6~52 months(mean 28 months).In all the 38 cases there were"excellent"outcomes in 17 cases"good"in 19 cases,"fair" in 0 case,and"poor" in 0 case in the acute traumatic extravasated blood of the ankle group.Impringement syndrome of the anterior ankle group:"excellent" in 15 cases"good" in 3 cases"fair"in 2 cases"poor"in 0 case.[Conclusion]Arthrotrauma and degranding are two reasons of the impingement syndrome of the anterior ankle,the initial stage arthroscope examination and treatment of the acute traumatic extravasated blood of the ankle without fracture and disbocating is the best active method to prevent the impingement syndrome of the anterior anlke,the clearing operation under the arthroscope is the best mininmally invasive treatment countermeasure for the impingement syndrome of the anterior ankle.

Objective To investigate the pharmacodynamics characteristics of continuously infused cisatracurium besylate during total intravenous anesthesia. Methods Sixty ASA Ⅰ - Ⅱ patients undergoing elective oromaxillo-facial region surgeon were randomly divided into 4 groups. 1.0, 2.0, 3.0 μg/ (kg · min ) of cisatracurium besylate was continuously infused differently in group Ⅰ, group Ⅱ and group Ⅲ, and 0.1 mg/kg of cisatracurinm besylate was injured interruptedly into group Ⅳ after anesthesia induction. Neuromuscular function was assessed using an accelerometer with train-of-four (TOF) stimulation, the maximum depression of T1and times to T1 recovered to 25%(the clinic time), 75%, 90%(the vivo time) were noted. The recovery index (time of T1 recovery from 25% to 75%) was also calculated. Results The drug consumptions of cisatracurium besylate in group Ⅰ and group Ⅱ were diminished than those in group Ⅲ and group Ⅳ [(59.1±9.6),(116.7±11.5)μg/kg vs (174.9±23.1), (177.2±20.4) μg/kg](P<0.01), and group Ⅲ and group Ⅳ were nearly (P>0.05 ). The maximum depression of T1, the clinic time and the vivo time in group Ⅰ, Ⅱ,Ⅲ were smaller than those in group Ⅳ [ ( 18.5±3.6)%, (6.4±2.7)%, 0 vs (25.0±0.0)% ] (P < 0.01 ), but there were. No significant differences in recovery index in 4 groups. The maximum depression was diminished (P< 0.01 ) and the clinic time and the vivo time were prolonged (P<0.05) with the inerease of the dosage of cisatracurium besylate in group Ⅰ, Ⅱ, Ⅲ. Conclusions With no cumulative effect, the duration of recovery of muscle relaxation is shortened and the recovery index of continuously infused eisatracurium besylate is prolonged. It indicates that the cisatracurium besylate is suitable for the continuously infusion for surgeon patients.

Independent check is one of the key measures of quality control (QC) in radiotherapy and is essential for the assurance of radiotherapy accuracy.In recent years,with the application of computer-aided system,the automaticity of independent check,as well as its accuracy and efficiency,increases.Meanwhile,QC has evolved from a device-centered to a process-centered program.Therefore,independent check has been increasingly systematic and specific.This review gives a brief summary of the implementation and development of independent check.

In vivo dosimetry (IVD) is currently the most direct and effective means of quality assurance.The electronic portal imaging device (EPID) has been widely used for IVD verification owing to its favorable dosimetric properties.In recent years,an increasing number of EPID-based IVD studies have emerged around the world.The purpose of this paper is to give an overview of the present progress in EPID-based IVD studies,and to provide a reference for the subsequent application of EPID in IVD.

Objective To evaluate the value of multi-slice spiral CT (MSCT) angiography in diagnosis of thoracic vascularemergency.Methods 25 cases suspected of thoracic vascular emergency were examined with MSCT. Two dimensional and three dimensionalimaging methods were used. Results Central pulmonary embolism 10 cases, aortic dissection 12 cases,aneurysm 2 cases and takayasuarteritis with stricture of kidney artery were found by two dimensional imaging(MPVR,CPR),and the extent, size and details of lesions couldbe showed well. The space relationship and calcifation of aorta were displayed in three dimensional imaging(SSD,VR,MIP). Therelationship between intraluminal embolism and the wall of pulmonary artery, as well as intimal flap and reentry of dissection could bevealuated by CTVE.Conclusion Associated with imaging post processing,MSCT angiography is an effective method in diagnosis of thoracic vascular emergency.

Objective To evaluate the effect of local arterial infusion (LAI) of medicine on the treatment of servere acute pancreatitis(SAP). Methods The clinical data of 85 cases of SAP were retrospectively analyzed, and divided into three groups according to the admitted time:Group A. 42 cases admitted from February 1982 to December 1993,treated mainly by operation. Group B. 23 cases, admitted January 1994 to Auguest 1996, treated mainly by non operation. Group C. 20 cases, from September 1996 to Auguest 2000. treated mainly by LAI. Results The secondary infection rate in group A, B and C were 47%(20/42),26%(6/23) and 10%(2/20) respectively. The mortality in group A ,B and C were 36%(15/42),22%(5/23) and 5%(1/20),respectively. The difference in the secondary infection rate and mortality between group A , B and group C showed obvious significance (P

Objective To evaluate the effect of the combination of dexmedetomidine and sufentanil on monitoring anesthesia care during burr-hole surgery for patients with chronic subdural hematoma. Methods 96 pa-tients underwent burr-hole surgery for chronic subdural hematoma with MAC were randomly divided into two groups:Group D and Group DS (n=48 in each group). Local anesthetic block was started at least 10 min after DEX and sufentanil infusion. Ramsay sedation scale of the two groups was maintained to 3. Anesthesia onset time, hemo-dynamics, the amount of rescue midazolam or fentanyl, the time to first dose of rescue midazolam or fentanyl, the to-tal number of intraoperative patient movements, postoperative recovery time, patient and surgeon satisfaction scores, and the adverse events were recorded. Results Compared with group D, anesthesia onset time was significantly less in group DS (13.68 ± 3.13 vs. 11.82 ± 2.43 min, P=0.002). More patients in group D required rescue midazol-am to achieve RSS=3 compared with group DS (31.25%15/48 vs. 12.50%6/48, P=0.023). Compared with group D, significantly fewer patients in group DS required rescue fentanyl to relieve pain (10.42%5/48 vs. 27.08%13/48, P = 0.036). Additionally, the total dose of rescue fentanyl in group DS was significantly higher (89.48 ± 23.27 vs. 125.28 ± 33.52μg, P=0.000), and the time to first dose of rescue fentanyl was longer than group D(18.34 ± 4.45 vs. 14.34 ± 3.63 min, P=0.000). The total number of patient movements during the burr-hole surgery was higher in group D than group DS (35.42%17/48 vs. 16.67%8/48, P=0.036). The time to recovery for discharge from the PA-CU (time to an Aldrete score ≥ 9) was significantly shorter in group DS compared with group D (17.54 ± 5.92 vs. 12.57 ± 5.28 min, P=0.000). Results from the patient and surgeon satisfaction scores showed significant differenc-es favoring group DS (P<0.05). More patients in group D showed higher levels of the overall incidence of bradycar-dia (37.50% 18/48 vs. 18.75% 9/48, P = 0.041) and hypotension(37.50%18/48 vs. 14.58%79/48, P=0.011)com-pared with group DS. Conclusions Compared with DEX alone, DEX-sufentanil associated with fewer number of in-traoperative patient movements, less amount of rescue scheme, could be safely and efficiently used for MAC during burr-hole surgery for patients with chronic subdural hematoma.

Objective To discuss the method and clinical effect of bilobed DIEP flap for repair of degloving injuries of the hand.Methods From June, 2013 to January, 2015, the bilobed DIEP flap were designed to repair 6 cases of degloving injuries of hand, of which the small leaf flap repaired separately defect of thumb, larger leaf flap repair 2nd-5th finger and palm and dorsum.The bilobed DIEP flap design were based upon anatomic study on deep inferior epigastric artery, superior epigastric artery, intercostal artery and its anastomosis.Results The largest area of main flap was 35 cm × 12 cm, and the deputy leaves of flap was 10 cm× 7 cm.All of the 6 flaps survived.One of them experienced distal end necrosis of epidermis.But it was healed by dressing changes.All of the 6 cases were followed up for average of 12 months (range, 6-20 months).All flaps were seen with good appearance, fully recovered protectve sensation and the active motion of the thumb was recovery.Moreover, the donor sites were closed directly and the appearance were satisfactory.Conclusion The bilobed DIEP flap is a satisfying choice in repairing degloving injuries of the hand in that it has reliable blood supply, can obtain the larger area of skin and leaves small injuries in targeted area.