Objective To explore the relationship between severe(≥grade 3 ) radiation pneumonitis (RP) and dose-volume histogram (DVH) parameters for non-small cell lung cancer (NSCLC) treated with three-dimensional conformal radiation therapy (3-DCRT). Methods Ninety-four patients with NSCLC treated with 3-DCRT were retrospectively analyzed. Clinical parameters were analyzed. DVH parameters analyzed were V20, V30, V40,mean lung dose (MLD),normal tissue complication probability(NTCP) ,and total dose. Results Age,sex, Karnofsky scored, performance status, forced expiratory volume in 1 second,presence of weight loss, preexisting lung disease, history of thoracic surgery, and history of chemotherapy were not associated with the risk of severe RP(P>0.05). However,in univariate analyses, V20, V30, V40, MID and NTCP were associated with severe RP(P<0.01). In multivariate analysis, MID and V30 were variable associated with severe RP(P<0.01). The severe RP was 0 when MLD < 10 Gy and 21%(8/39) when MLD between 10 Gy and 20 Gy but 35%(7/20) when MLD > 20 Gy,it was 0 when V30 < 25% and 12%(4/33) when V30 between 25% and 35% but 38%(11/29) when V30 >35%. Conclusion MLD and V30 are significant predictive factors for severe RP and they should be limited to ≤20 Gy and ≤ 35% in order to reduce severe RP.

0.05), while there was significant difference in RI and S/D between the group without UCAN and the groups of UCAN with two loops and with three loops (P

Objective To study the prevention,diagnosis and treatment of the pulmonary embolism after abdominal surgery.Methods The clinical data of patients with acute pulmonary embolism(PE) after abdominal surgery between July 2008 and June 2012 were analyzed retrospectively.The high-risk patients received D-dimer,deep venous ultrasound and pulmonary CT examination to confirm the diagnosis postoperatively.Anticoagulation,thrombolysis,inferior vena cava filter placement were carried out in these patients.The high-risk patients received low molecular weight heparin(LMWH) to prevent PE from January 2010.Results 5 patients with PE survived and 3 patients died.The incidence of venous thromboembolism event was 0.43％ (13/3012) before January 2010 and PE was 0.20％ (6/3012).The incidence of venous thromboembolism event was 0.15％ (7/4803) after taking preventive measures and PE was 0.04％ (2/4803).There was no PE within 1 week since using LMWH after 2010.Lower limb DVT was found in 7 patients including 2 patients with PE after LMWH discontinuance within 2-3 weeks postoperatively.Conclusions Early prevention,diagnosis and treatment of postoperative PE are important for high-risk patients.

Objective To explore the risk factors of hospital infection for hypertensive intracerebral hemorrhage ( HIGH). Methods 408 patients from Department of Neurology whose length of stay equaled or exceeded 72 hours and who fitted in with the criterion for the diagnosis of hospital infection were chosen as the HICH infection group while HICH patients without hospital served as the control group. The risk factors for HICH were studied by means of both single factor analysis and multifactor analysis. Results Of more than 30 possible risk factors that were studied by means of single factors analysis, more than 20 manifested marked difference (P < 0.05). Uncondition Logistic regression analysis of the more than 20 variables indicated that rise of inhalation of food resulting from indwelling, stomach tube,kinds of antibiotics used,spray inhalation and fasting blood-glucose,accidental were the risk factors of HICH infection. Conclusion HICH infection results from the synergetic action of various factors and hospital infection could be controlled and reduced by strengthening supervision.

This article introduces a new educational model-Ability Standard Teaching Mode,which emphasizes that students should participate in teaching and promotes the students to change their thinking style from memory and imitation style to thought and creativity style.

Objective: To investigate the effects of NO on cholestasis caused by TPN. Methods: 24 newborn rabbits were divided into 3 groups: control group, TPN for 1week group and TPN for 2weeks group. After 7 or 14 days, serum liver function test was determined using automatic biochemical analyzer, NO levels in serum and liver, liver NOS activity and iNOSmRNA expression were determined respectively by the Griess method, spectrophotometric analysis and in situ hybridization. Results: After having received TPN administration for 7 or 14 days, the NO levels of serum and liver, liver NOS activity and iNOSmRNA expression increased significantly than those in control group(P

Objective: To explore the effectiveness of maintaining the stability between the fourth and the fifth metacarple base during the treatment in the hamate-metacarpal joint injury. Methods: Between September 2015 and June 2017, 13 cases of hamate-metacarpal joint injury were treated, including 12 males and 1 female, aged from 17 to 55 years (mean, 30.8 years). The injury causes included heavy boxing in 10 cases and falling in 3 cases. There were 2 cases of simple fourth metacarpal basal fracture, 1 basal fracture of the fourth metacarpal bone combined with intermetacarpal ligament fracture, 7 fractures of the fourth and fifth metacarpal base, 2 fourth metacarpal basal fractures combined with the fifth metacarpal basal fracture dislocation, and 1 base fracture of fourth and fifth metacarpal bone combined with hamate bone fracture. The time from injury to operation was 5-11 days (mean, 7.2 days). According to different damage degree and stability change between the fourth and the fifth metacarple base, a preliminary classification was made for different degrees of injury: 2 cases of type Ⅰ, 1 case of type Ⅱ, 7 cases of type Ⅲ, 2 cases of type Ⅳ, and 1 case of type Ⅴ. The patients were treated with corresponding internal fixation methods under the principle of stability recovery between the fourth and fifth metacarple base. Results: All the incisions healed by first intention without infection or skin necrosis. All the 13 patients were followed up 6-18 months with an average of 9.4 months. All fractures healed clinically, and the healing time was 5.5-8.0 weeks with an average of 6.3 weeks. No complication such as plate breakage, fracture dislocation, fracture malunion, and bone nonunion occurred. Hand function was evaluated according to the total active motion (TAM) functional evaluation standard of hand surgery at 6 months after operation, and the results was excellent in 9 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 92.3%. Conclusion: Stability between the fourth and fifth metacarple base is of great significance to the classification and the treatment of the hamate-metacarpal joint injury.

Objective: To explore the clinical effect between bridge locking anatomical plate with supported plate based four column in type III Riiedi-Allgower Pilon fracture. Methods: Retrospective study was performed on the clinical data of type III Riiedi-Allgower Pilon fracture undergoing surgery. Patients were divided into two groups according to internal fixation. Some parameters including operation time, blood loss, and drainage, healing time, full burden time, functional score and pain score were analyzed. Results: There was no significant difference between the operation time, blood loss and drainage between the two groups(t = 0. 37, P>0. 05;t = 0. 71, P>0. 05;t = 0. 24,/>>0.05). The healing time and full burden time of experimental group was lower than control group significantly ((=1.56, P<0. 05;i = 2.43, P<0.05). For American Orthopaedic Food and Ankle Society(AOFAS) score and visual analogue score(VAS) in postoperative 1 month, there was no significant difference between the two groups. For AOFAS score and VAS score in experimental group was lower than control group after 3 months (P<0. 05). There was no significant difference between two groups in reduction quality Burwell-Charnley score and complication between two groups. Conclusion Supported plate based four column could improve the life quality of patietns with Pilon fracture, which is worth to recommed in clinical application.

Objective:To investigate the clinical efficacy of modified Bingtitang in treatment of type 2 diabetes mellitus(T2DM) and its effect on pancreas islet function. Method:A total of 108 patients with T2DM were divided into two groups according to the digital number table method, with 54 cases in each group. The control group were given routine therapy of diabetic diet, proper exercise and blood sugar control, while the treatment group were orally given traditional Chinese medicine (TCM) and modified Bingtitang in addition to the therapy of the control group. The blood sugar, pancreas islet function-related indexes, TCM syndrome score, serum retinol binding protein 4 (RBP4) and Betatrohin levels were compared between two groups before and after treatment. The total effective rate was also compared. Result:After treatment, the fasting blood glucose (FPG), glycated hemoglobin (HbA1c), blood glucose variation coefficient (CV-FPG), insulin resistance index (HOMA-IR) of the treatment group were lower than those of control group (P<0.01), while the ratio of insulin secretion index (HOMA-IS), 30-minute insulin increment (I30) and blood glucose proliferation (G30) to(ΔI30/ΔG30)of treatment group were higher than those of the control group (P<0.01). The TCM score and the serum RBP4 level were lower than those of control group (P<0.01), while Betatrohin level was higher than that of the control group (P<0.01), and the total effective rate was higher than that of control group (P<0.05). Conclusion:In addition to the routine treatment, modified Bingtitang can effectively control blood sugar, improve pancreas islet function, and alleviate TCM syndromes, with a significant effect on T2DM. Its mechanism may be related to the regulation of serum RBP4 and Betatrohin levels.

Human epidermal growth factor receptor-2 （HER-2）-positive breast cancer has higher predilection to metastasize and invade other organs， leading to poor prognosis. The anti-HER-2 drugs， such as trastuzumab， pertuzumab， and trastuzumab emtansinehas， can remarkably prolong the disease free survival （DFS） of patients. However， frequent multidrug resistance， tumor recurrence and metastasis， and adverse reactions such as cardiotoxicity and gastrointestinal discomfort caused by adjuvant therapy are still challenges for the treatment of HER-2-positive breast cancer. The understanding of breast cancer in traditional Chinese medicine （TCM） has a long history. In thousands of years of inheritance and innovation， a standardized treatment system with TCM characteristics has been gradually formed， which shows unique advantages and significant curative effects in breast cancer treatment. The treatment principles of ''treatment based on syndrome differentiation''， ''treatment based on stages and types''， ''treatment according to individual conditions''， and ''treatment of different viscera and viscera based on the toxin and pathogen'' are closely related to the precise treatment concept. In view of the challenges in the treatment of HER-2-positive breast cancer， such as multidrug resistance， tumor recurrence and metastasis， cardiotoxicity， and gastrointestinal discomfort， this paper summarizes the characteristics of TCM in reversing the multidrug resistance， inhibiting tumor recurrence and metastasis， prolonging DFS， improving prognosis， reducing adverse reactions caused by adjuvant therapy， and improving the quality of life after breast cancer surgery according to the principles of reinforcing healthy Qi and eliminating pathogen， and treatment based on syndrome differentiation. This article is expected to serve as a reference for TCM treatment of HER-2 positive breast cancer.