Objective To evaluate the optimized simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) plans in cervical esophageal carcinoma underwent prophylactic lymphatic irradiation.MethodsSix patients with cervical esophageal carcinoma were studied.The gross tumor volume (GTV) and clinical target volume (CTV) (including bilateral mid-lower neck and supraclavicular lymph drainage regions,upper mediastinal lymph drainage regions) were delineated on sim-CT images,GTV and CTV were uniformly expanded by 5 mm to create PGTV and PTV.Five fields(5F) ,7F and 9F SIB-IMRT plans were designed.The prescribed doses to PGTV and PTV were 66 Gy and 60 Gy in 30 fractions respectively.The parameters of dose-volume histograms in three groups planning were compared.Results The values of conformity index(CI) of PGTV were 0.56,0.62 and 0.69 (F =6.22,P ＜0.01 ),the V66 with 88.24% ,95.03% and 94.91% ( F = 4.39,P ＜ 0.05 ) and D95 with 6539.67,6601.83 and 6602.00 cGy (F=4.46,P ＜0.05) in 5F,7F and 9F SIB-IMRT plans.The values of CI,V66 and D95 of PTV were 0.80,0.85 and 0.87 (F=11.29,P＜0.01),with 91.64%,94.05% and 95.06% (F=4.10,P＜0.05) and with 5934.00,5987.17 and 6006.33 cGy (F =4.01,P ＜0.05).The values of maximal dose of spinal cord were 4707.17,4497.83 and 4357.00 cGy( F = 11.26 ,P ＜0.011 ) in 5F ,7F and 9F SIB-IMRT plans.The values of all dosimetic parameters about PGTV and PTV were same in 7F and 9F SIB-IMRT plans ( all P ＞ 0.05 ).Conclusion 7F-SIB-IMRT plan is best one scheme for cervical esophageal carcinoma underwent prophylactic lymphatic irradiation.

Aim Our previous study has found that ur-solic acid( UA) increased intracellular reactive oxygen species ( ROS ) production and adenosine monophos-phate-activated protein kinase ( AMPK ) phosphoryla-tion, inhibited signal transducer and activator of tran-scription 3 ( STAT3 ) phosphorylation and cyclooxygen-ase-2 ( COX-2 ) expression in gastric cancer cells . However , the molecular mechanism by which UA in-hibits COX-2 expression in gastric cancer cells has not been fully clarified .In this study we aimed to further clarify the signal transduction pathways involved in the UA-mediated inhibition of COX-2 expression in gastric cancer cells .Methods Human gastric cancer cell lines SGC-7901 and MKN-45 were routinely cultured in RPMI-1640 medium supplemented with 10% heat-in-activated fetal calf serum .Sub-confluent cell cultures were pre-treated with antioxidant N-acetylcysteine ( NAC) , AMPK activator 5-amino-4-imida-zolecarbox-amide-riboside ( AICAR ) , AMPK inhibitor compound C, or STAT3 inhibitor WP1066 and then treated with or without UA for 24 h.The expression of AMPK and phosphorylated AMPK ( p-AMPK ) , STAT3 and phos-phorylated STAT3 ( p-STAT3 ) , as well as COX-2 was detected by Western blot analysis .Results Antioxi-dant NAC and AMPK inhibitor compound C blocked UA-induced inhibition of STAT 3 phosphorylation and down-regulation of COX-2 expression in gastric cancer cells.Both AMPK activator AICAR and UA inhibited STAT3 phosphorylation and COX-2 expression; the combination of two drugs resulted in further reduction . STAT3 inhibitor WP1066 did not affect UA-induced AMPK phosphorylation , whereas it inhibited STAT3 phosphorylation and COX-2 expression .The inhibitory effects on the STAT3 phosphorylation and COX-2 ex-pression were significantly enhanced when SGC-7901 and MKN-45 cells were treated simultaneously with WP1066 plus UA.Conclusion UA inhibits COX-2 expression in gastric cancer cells , which may be medi-ated through ROS/AMPK/STAT3 signal transduction pathway .

BACKGROUND:Surrounding structure of intracristal ventricular septal defects(IVSD) and membranous ventricular septal defects(MVSD)is complicated,and it is difficult to perform transcatheter closure treatment.Corresponding animal models should be established to define an optimal interventional therapy.OBJECTIVE:To prepare the animal models of IVSD and MVSD under echoeardiogram location.DESIGN:Animal modeling experiment.SETTING:Department of Cardiology,Zhongshan Hospital Affiliated to Fudan University.MATERIALS:Six healthy adult dogs,irrespective of gender,were purchased from Shanghai Experimental Animal Center.Aorta and great saphenous vein stapler-puncher(St.Jude corporation,USA)was used.The main improvement is to cut the plastic shell even,thin,or shorter in order to reduce the resistance when puncturing the"purse"in the fight ventficle and the interventficular septum.Sonos 5500 multifunction ultrasonoscope(Philips,USA)was used,and the frequency of the probe was between 2.5-3.5 MHz.METHODS:Experiments were performed at the Zhongshan Hospital Affiliated to Fudan University and Central Laboratory of Shanghai Institute of Cardiovascular Disease from April to July 2006(biosaflety level 2).After anaesthesia,6 adult dogs were fixed at decumbent position.The interventricular septum was punetured to make the preparation with the location of echocardiography(ECHO)by using the modified aorta and great saphenous vein proximal stapler-puncher.Animal intervention met the Animal Ethical Committee of Fudan University.MAIN OUTCOME MEASURES:One week after the surgery,transthoracic echocardiography examination was used to check the VSD site,the highest shunt flow rate,the pressure difference between both sides of the VSD,as well as pulmonary artenal pressure.RESULTS:The VSD models were successfully established in three survivals and included in the final result.Two models of IVSD and one model of MVSD were examined by ECHO one week after the surgery.The diameter of VSD ranges from 1.8 to 3.6 mm.The Peak Flow Rate of the VSD ranges between 1.8 and 4.0 m/s.The pressure difierence of both sides of the VSD ranges between 42 and 51 mm Hg.The pulmonary arterial systolic pressure ranges from 23 to 29 mm Hg.CoNCLUSION:Located by the ECHO,it is possible to establish animal models of the IVSD and MVSD with the modified aorta and great saphenous vein proximal stapler-puncher.

The application of TCM“Preventive Treatment for Disease”in community health care is a major approach to implementing the prevention-first health policy and realizing access to basic health services for all.Covered first in the paper is the significance of TCM“Preventive Treatment for Disease”in community health care.It is followed by a systematic description of the innovative community health care model in Hangzhou in 2008.This innovation started in 2009 to apply the TCM“Preventive Treatment for Disease”in community health care.The authors described the preliminary practice,specific measures and the main results of TCM“Preventive Treatment for Disease”in community health care.They went on to recommend the service model of TCM“Preventive Treatment for Disease”in community health care and provide references for application of TCm in community health care.

To determine the efficacy and safety of Zhenjujiangya tablets combined with long-acting antihypertensive drugs in the patients with hypertension. Methods:A controlled study was carried out among 220 patients meeting the inclusion / ex-clusion criteria. All the patients were randomly divided into the experimental group and the control group. Both groups were treated with long-acting antihypertensive drugs as usual. The 110 patients in the experimental group were orally treated with Zhenjujiangya tab-lets ( bid) , while the other 110 patients in the control group were orally treated with Zhenjujiangya simulated tablets ( bid) , and the treatment course was 4 weeks. The efficacy was assessed using the reduction range of blood pressure, the clinical symptom score of hy-pertension and the indicators of ambulatory blood pressure monitoring as the indices, and the safety was assessed by the symptoms, signs and laboratory tests. Results:After the four-week treatment, the systolic blood pressure, diastolic blood pressure and hyperten-sion clinical symptom score were significantly decreased in the two groups, and the changes in the experimental group were more signifi-cant than those in the control group (P<0. 01). The effect on the clinical symptom of the experimental group was better than that of the control group (P<0. 01). There was no significant difference in systolic blood pressure, diastolic blood pressure and the number of abnormal blood pressure in 24h, daytime and nighttime (P>0. 05). After the treatment, the changes in average systolic blood pres-sure in 24h and daytime in the experimental group showed statistically significant difference (P<0.05),while those in the control group were without statistically significant difference (P>0. 05), and the number of abnormal blood pressure in 24h and daytime in the experimental group exhibited reduction trend. There were no significant difference in the incidence of adverse events between the two groups (P>0. 05). Conclusion:Long-acting antihypertensive drugs combined with Zhenjujiangya tablets can further improve the antihypertensive efficacy without significant adverse reactions, which is suitable for clinical application.

Objective To evaluate the effectiveness of comprehensive lifestyle modification in the primary health care system on status of pre-chronic diseases in a conventional healthcare program.Methods Two hundred and twenty-nine adult volunteers in 5 conventional healthcare centers were divided into 4 groups:group of prehypertension(n=67),group of prediabetes(n=38),group of abnormity serum cholesterol(n=71)and group of osteopenia(n=53).A muhicomponent behavioral intervention including education,physical activity,dietary practice,cease smoke,calcium supplement and exposure to sunlight was conducted for 12 months.The main outcome of each group was blood pressure,blood glucose,serum cholesterol and bone mineral density.Results Over 12 months,compared with the status before intervention,participants in each group were statistically significantly improved,the mean net reduction in systolic BP/diastolic BP was 9.4 mm Hg/6.6 mm Hg(1 mm Hg=0.133 kPa,t=5.93/8.29.P＜0.05)in group of prehypertension;the reductions of blood glucose,serum cholesterol were 0.9 mmol/L(t=3.69,P＜0.05)and 0.5 mmol/L(t=4.09,P＜0.05)in group of prediabetes and group of abnormity serum cholesterol,and the increase of bone mineral density on lumbar spine was 0.015 g/cm2(t=2.03,P＜0.05)in group of osteopenia,Conclusions For chronic disease prevention,ater one year the comprehensive lifestyle intervention produced beneficial changes in diet,physical activity,and biochemical parameters.This type of intervention is a feasible option to prevent chronic disease and should be implemented in the primary health care system.

Three weeks’ training, visiting and demonstrating classes in Michigan State University gave us an opportunity to understand the education system, the teaching characteristics and the “students centered”teaching principle of USA. Some reasonable teaching methods were applied in the class which may embody the student-oriented teaching aim and develop the students’ subjective initiative. The teaching effect showed that most students were fond of the teaching strategies and they also did good job in final tests.

Objective To evaluate the relationship of preoperative neutrophil-lymphocyte ratio (NLR) with clinicopathological features and prognosis of colorectal cancer in middle-aged and elderly patients.Methods A retrospective analysis was performed in 212 patients with colorectal cancer in the First Affiliated Hospital of Nanjing Medical University from January 2011 to June 2013.All patients were divided into middle-aged group (46-65 year old,n=130) and old-aged group (66-89 year old,n=82),The optimal cut-off point of NLR was identified by the area under receiver operating characteristic curve,while NLR ＞ 3.13 and NLR≤3.13 were classified as high and low NLR group.The clinicopathological features and prognosis between the two groups were compared.Results There was no difference in gender,tumor growth site,depth of invasion,tumor embolus,lymphatic metastasis,distant metastasis,TNM stage between low and high NLR group (allP＞ 0.05).However,the difference between high NLR group and low NLR group in old-aged group with diabetes mellitus was statistically significant (P＜0.05).The 1-,2-,and 3-year survival rate of the overall 212 patients were 96.2％ (204/212),87.7％ (186/212) and 74.5％ (158/212) In middle-aged group,the 1-,2-,and 3-year survival rates were 98.8％ (85/86),90.7％ (78/86) and 84.9％ (73/86) respectively in low NLR group,but 95.5％ (42/44),84.1％ (37/44) and 72.7％ (32/44) respectively in high NLR group,(allP＜0.05).In old-aged group,the 1-,2-,and 3-year survival rates were 95.7％ (44/46),89.1％ (41/46) and 73.9％ (34/46) respectively in low NLR group,but 91.7％ (33/ 36),83.3％ (30/36) and 52.8％ (19/36) respectively in high NLR group (all P＜0.05).Cox regression showed that TNM stage and NLR were independent risk factors for the prognosis of the middle-aged and elderly patients with colorectal cancer (P＜0.05 or P＜0.01).Conclusions Preoperative NLR ＞ 3.13 suggest that the prognosis is poor in middle-aged and elderly patients with colorectal cancer.

The purpose of education is to cultivate talents who can master the ability of self-learning lifelong. With the rapid development of multimedia technology, the knowledge carrier represented by micro curriculum plays a very important role in improving students' self-learning ability. In traditional Chinese medicine college, due to the short of time, weak learning foundation, the ability of self-learning is hard to improve in the modern medical courses such as biochemistry. This is not conducive to the cultivation of modern talents of Chinese medicine. In this paper, we chose the biochemistry teaching in TCM college as an example, and discuss how we can make the application of micro courses reasonably in the teaching process. This study was regarded as a starting to improve the students' self-learning ability effectively.

Objective To determine the incidence of breast cancer?related lymphedema ( BCRL) in China and to analyze the associated risk factors. Methods A retrospective analysis was performed on the clinical data and the incidence of BCRL in 281 patients who were newly diagnosed with breast cancer and received surgery. The incidence of BCRL was evaluated using arm circumference measurement and Norman questionnaire. The risk factors for lymphedema were analyzed using chi?square test and logistic regression model. Results In all patients,the incidence rates of BCRL determined by arm circumference measurement and Norman questionnaire were 31?7% and 27?0%, respectively. The multivariate analysis showed that postoperative radiotherapy,a preoperative body mass index no less than 24 kg/m2 ,a large axillary lymph node dissection area,and a large number of positive axillary lymph nodes significantly increased the risk of BCRL (HR=2?87,P=0?042;HR=2?54,P=0?011;HR=1?97,P=0?037;HR=1?06,P=0?023). Moreover, patients with breast cancer and hypertension had 1?74?fold higher risk of BCRL than those with normal blood pressure. Conclusions The incidence of BCRL is still very high. However,most of patients only have mild edema. Postoperative radiotherapy, a large axillary lymph node dissection area, a large number of positive axillary lymph nodes,a high preoperative body mass index,and hypertension are risk factors for BCRL.