Objective To analyze the evaluation value of ABCD2 combined with carotid ultrasound on the prediction of cerebral infarction after transient ischemic attack. Methods The clinical data of 133 patients with TIA admitted from July 2014 to December 2015 were analyzed. We score patients according to the standard of ABCD2 score and carotid ultrasound. The incidence of cerebral infarction within 7 days was observed. Results In the 133 TIA patients 35(26.3%) progressed to cerebral infarction. The 7-day incidence of cerebral infarction was 7.1% in patients with an ABCD2 score of low risk (0-3), 25% with a score of moderate risk(4-5), and 40% with a score of high risk(6-7). The difference of the incidence of cerebral infarction was significant between the low and moderate risk stratification (P < 0.05). The 7-day incidence of cerebral infarction was 39.5% in patients with carotid plaque and 75.0% in patients with carotid stenosis , both higher than the control group (P < 0.05). In the ABCD2 score ≥4 group, the incidence of cerebral infarction in the patients with abnormal carotid ultrasound was 38.4% ,significantly higher than the patients with normal carotid ultrasound (P < 0.05). Conclusions The ABCD2 score is effective to predict short-term risk of cerebral infarction in the patients with TIA. Combination with carotid ultrasound can improve the predictive accuracy of 7- day risk of cerebral infarction after TIA.

To observe the clinical effect of Yangxue Zhitong pills combined with Shuangbaisan on the treatment of children with hip synovitis in.Methods 60 children with hip synovitis from November 2013 to May 2015 were randomly divided into the observation group and the control group,30 cases in each group.The observation group were given conventional treatment and the control group was given Yangxuezhitong pills combined with Shuangbaisan.Hip VAS and blood flow index in the two groups were followed-up and compared.Results (5 days after treatment,hip VAS in the observation group(3.50±0.46),was lower than that of the control group(4.51±0.55)(P<0.05).②CRP,TNF-α,IL-6,IL-1 level in the observation group were(3.01±1.73mg/L,15.58±5.46pg/mlL,74.9±19.4pg/mL,22.57±4.01ng/L),which were lower than those in the control group(5.69±2.05mg/L,32.47±4.16pg/mL,97.6±24.2pg/mL,32.17±4.38ng/L)(P<0.05).③After treatment,total effective rate in the observation group(93.3％)was higher than that in the control group 66.7％(P<0.05).Conclusion The clinical therapeutic effect of Yangxue Zhitong pill combined with Shuangbaisan on the treatment of children with hip synovitis is exact,which is worthy of further clinical research and application.

Objective To analysis TORCH pathogens infection of women in childbearing age in Beijing area,and to explore the relationship of TORCH infection with the level of TNF-α.Methods Using ELISA detect serum IgM and IgG antibody of TOX,RV,CMV,HSV-I and HSV-II from 970 cases of women during Jan.2015 to Dec.2015.TNF-αlevels of TORCH infection and control group were also determined by ELISA,the results were analyzed.Results Of 970 women,the IgM pos-itive rates of TOX,RV,CMV,HSV-I and HSV-II were 1.65%,2.16%,4.54%,17.42% and 6.08%,respectively.The IgG positive rates of them were 3.81%,93.40%,92.47%,64.02% and 14.64% respectively.The positive rates of CMV and HSV-I IgM for women <30 years old were higher than that of ≥30 years old (χ2=4.558,4.051;P<0.05).HSV-I IgM had statistically higher infection rate in summer than other seasons (χ2=5.356,P<0.05).TNF-αlevels of TORCH IgM positive group were elevated compared with control group (t=10.219,P<0.01).Conclusion Women planning pregnancy were easier infected by TORCH in Beijing area during 2015 with specific epidemiological features.TNF-αalso plays detri-mental role during reproduction of childbearing age women.

Objective To evaluate the dose distribution of target volume and normal tissues with different treatment planning such as three dimensional conformal radiotherapy(3DCRT) ,simplified intensity modulated radiotherapy(sIMRT) ,and intensity modulated radiotherapy (IMRT) for patients with radically resected rectal cancer. Methods Ten male patients with stage Ⅱ and Ⅲ rectal cancer after radical resection (Dixon surgery) were enrolled in this study. 3-field or 5-field 3DCRT,slMRT and 5-field or 7-field IMRT plans were performed for each patient. The dose distributions of target volume and normal tissues,conformal index(CI) and heterogeneous index(HI) were analyzed using the dose-volume histogram(Dvit). The prescription dose was 50 Gy in 25 fractions. Results The CI for PTV of IMRT and sIMRT was superior to 3DCRT. Conversely,the HI for PTV of 3DCRT was superior to sIMRT and IMRT. sIMRT and IMRT can protect the organs at risk better than 3DCRT. The mean of total MU for 3DCRT3f,3DCRT5f, sIMRT, IMRT5f and IMRTT7f was 482±13,504±11,455±42,841±36 and 884±46, respectively. Conclusions Comparing with 3DCRT plans and IMRT plans, sIMRT plan was the optimal plan for clinical practice. All of the three radiotherapy techniques can protect the rectal stump and anal canal well with the prescription dose of 50 Gy.

Objective To evaluate the safety and efficacy of three types of anesthesia methods in elderly patients with coronary heart disease undergoing unilateral lower extremity surgery.Methods Totally 65 patients with coronary heart disease of cardiac function Ⅰ-Ⅱ (NYHA),scheduled for undergoing unilateral lower limb surgery were randomly divided into three groups:local nerve block anesthesia of lumbar plexus plus the sciatic nerve (21 cases),general anesthesia (19 cases),epidural anesthesia (25 cases).Systolic blood pressure (SBP),heart rate (HR),pulse rate and blood oxygen saturation (SPO2) at 0 min,10 min,20 min,30 min,40 min after surgery at the end of the surgery were observed and recorded.The change of troponin Ⅰ (cTnI) at 3 day after surgery was observed.Visual analoguc scales (VAS) scores.movement reaction,the infortnation of muscle relax and corresponding management were recorded in order to detect anesthesia efficacy.Results The excellent and satisfactory rate of anesthesia efficacy of three groups were 17 cases (81.0％) and 4 cases (19.0％),17 eases (89.5％) and 2 cases (10.5％),22 cases (88.0％) and 3 cases (12.0％) (all P＞0.05).In epiduralgroup compared with other groups,SBP were decreased (both P＜0.05).cTnI in nerve stimulator group was decreased (all P＜0.05) at 1 and 3 day after surgery compared with general anesthesia group,and at 3 day after surgery,cTnI level in nerve stimulator group was lower than other two groups(all P＜0.05).Conclusions The nerve stimulator guided nerve block is the most safe method among general anesthesia and epidural anesthesia in elderly patients with coronary heart disease scheduled for lower extremity surgery.

This article systematically introduced the development of Smart Healthcare mode in Hangzhou. From the aspects of connotation, pattern, characteristics and the change of medical treatment mode, the authors pointed out that the development of Smart Healthcare must follow such principles as satisfaction of the people, enhanced inter-departmental synergy, government-guided social participation, and full involvement of medical workers.

Objective To determine pathogens and epidemiological characteristics of adults with acute respiratory infection (ARI) in Beijing area.Methods During 2015,a total of 2 700 cases of ARI were sampled and detected for 9 respiratory pathogens including Legionella pneumophila type1 (LP1),mycoplasma pneumoniae (MP),qrickettsia (COX),chlamydia pneumoniae (CP),adenovirus (ADV),respiratory syncytial virus (RSV),influenza virus type A and B (INFA,IFVB) and parainfluenza viruses type1,2 and 3 (PIVs) using indirect fluorescence immunoassay.Results A total of 620 cases of ARI were tested positive with positive rate of 22.97％ (620/2 700).MP had the highest prevalence followed by LP1,INFB,COX,CP,PIVs,INFA,ADV and RSV in turn.There were 109 cases found mixed infection with the proportion of 17.58％ (109/620).Mixed infection of LP1 along with MP was the most common pattern.The highest detection rate of pathogens was observed in November,whereas the lowest in April in terms of months (x2 =31.288,P＜ 0.01).Different pathogens had distinct prevalent features.The prevalence of male was significant higher than that of female (x2 =6.402,P =0.011).As for stratificated by age,the middle-aged people had the highest infection rate (x2 =9.094,P=0.059).There was no significant difference between the out-and in-patient in terms of infection rate (x2 =0.114,P=0.736).Conclusion MP,LP1 and INFB accounted for ARI of adults in Beijing area during 2015.

Objective To commission a Mobetron intra-operative mobile accelerator and analyze the characteristics of its electron beams. Methods The dosimetrie characteristics of the electron beams genera-ted by Mobetron accelerator were measured and compared with those generated by conventional accelerator (Primus, Siemens). M oberton accelerator can generate electron beams of nominal energies of 4,6,9 and 12 MeV. The measurement items were as followings : percentage depth dose perpendicular to water phantom sur-face and beam profiles parallel to water phantom surface, output factors, applicator leakage, electron beam at-tenuation made by lead blocks,and machine output calibration. The measurement devices included a three-dimensional ( 3 D) water scanning phantom, an electrometer, a 0.6 cm3 Farmer ionization chamber, a parallel-plate ionization chamber and solid water slabs. During measurement, all applicators of different tilt angles and diameters were attached to the machine head,and their ends were adjusted to be tangent to the phantom surface. Results Except for the 12 MeV,skin dose for all energies was no more than 90%. The skin dose was higher for Mobetron accelerator electron beams than for regular electron beams. The Dmax depth in water for a 10 cm flat applicator were 0.7,1.3,2.0 and 2.2 cm for the 4 energies,respectively. The depths of 90% dose were 1.0,1.8,2.7 and 3.6 cm, respectively. The selected flat applicator was just 1 cm larger than the tumor bed. But for the beveled applicators,the field flatness and symmetry became worse,and con-sequently,the applicator size had to be selected based on the isodose distribution. The leakage dose at 1 cm outside the applicator was 1.2% ,5.1%, 10.0% and 9.1%, respectively. The lead thickness for full block was 1.5,3.0,4.5 and 6.0 mm,respectively. Conclusions Through the commissioning of Mobetron accel-erator, the machine characteristics are understood, and the data for clinical implementation and routine quality assurance are acquired.

Background and purpose: The position of thymidine kinase 1 (TK1) expression during cell division is in the cytoplasm. It is a catalytic enzyme to convert deoxythymidine into thymidylate. It is the key enzyme of pyrimidine salvage pathway. The aim of this study was to analyze the serum expression level of TK1 in patients with breast cancer, and explore the application of serum TK1 test in clinical assessments of diagnosis, treatment and prognosis for breast cancer. Methods: Patient data were collected from the patients admitted in Comprehensive Breast Health Center at Rui Jin Hospital. Chemiluminesence dot blot assay was used to detect serum TK1 levels in 145 breast cancer patients and 55 patients with breast ifbroadenoma. The correlations of serum TK1 levels with breast tumor biological behavior was further studied. Results:Serum TK1 expression levels was signiifcantly increased in breast cancer patients [(2.749±0.122)pmol/L] when compared to breast fibroadenoma patients[(1.319±0.126)pmol/L, P<0.000 1]. Serum TK1 levels were statistically increased in patients with lymph node metastasis (P=0.049), distal metastasis (P=0.003 1), and late TNM stages (P=0.01). No serum TK1 level differences were found in patients with different ages (P>0.05), different tumor grades (P=0.453) and different tumor size (P=0.908). Preoperative imaging results including breast ultrasound, breast mammography and breast magnetic resonance were analyzed by assessments of BI-RADS category, and serum TK1 levels in patients with different BI-RADS categories were studied. Serum TK1 levels in patients with breast ultrasound BI-RADS categories 4C-6 were signiifcantly higher than those with category 0-4B (P<0.001). Consistently, the serum TK1 levels in patients with MR BI-RADS categories 4C-6 were higher than categories 0-4B (P=0.005). The serum TK1 levels in patients with mammography BI-RADS categories 4C-6 were higher than categories 0-4B (P=0.032). The serum TK1 levels were signiifcantly increased in patients with ER high expression in breast tumor tissues than those with low expression (P=0.034). Serum TK1 levels had no differences in patients with different expression levels of PR, HER-2 and MIB-1 (P>0.05). Most patients were followed up in our outpatient department for about 2 years. No progression-free survival differences were found in 2years. Conclusion:Serum TK1 test might be a potential tool for screening, prognosis determination and effect evaluations of targeted therapy in breast carcinoma.

ObjectiveTo evaluate the inter-and intra-fractional clinical target volume (CTV) positioning errors of patients receiving postoperative simplified intensity-modulated radiotherapy (SIMRT) using cone beam computed tomography (CBCT).MethodsTwelve patients with liver tumors underwent postoperative SIMRT.CBCT images were acquired before and after the treatment.The clipbox volume for registration included the fiducial markers in the tumor bed and excluded the ribs and vertebral bodies.If any translational parameter of setup error before treatment exceeded 3 mm or rotational parameter exceeded 3°,the treatment couch was adjusted and a verification CBCT was acquired to assess residual setup error.Automatic bone match was used.A total of 214 acquisitions of CBCTs in 111 groups were analyzed.Inter-fractional translational CTV positioning errors in left-right (x),superior-inferior (y) and anterior-posterior (z) axis were calculated in 111 groups,and intra-fractional translational CTV positioning errors in 70 groups.Clinical to planning target volume (PTV) margins were calculated according to the formula:margin =2.0 ∑ + 0.7σ ( ∑ is systematic error,σ is random error).ResultsInter-fractional translational CTV positioning errors in x,y and z axis were -0.03 mm,-0.43 mm,1.02 mm,with systematic error ( ∑ ) of 1.50 mm,5.89 mm,1.97 mm,and random error (σ) of 1.76 mm,4.13 mm,2.42 mm,respectively.Intra-fractional translational CTV positioning errors in the x,y,z axis were 0.04 mm,0.86 mm,- 0.46mm,with systematic error (∑) of 0.46 mm,1.14 mm,0.31 mm,and random error (σ) of 0.95 mm,1.38 mm,0.91 mm,respectively.The calculate CTV to PTV margins were 4.5 mm,15.0 mm,5.8 mm in the x,y,z axis,respectively.ConclusionsThe CTV errors were inevitable when patients with liver tumors received SIMRT.Fiducial markers placed in tumor bed during operation were helpful for accurate positioning error analysis.