Objective To discuss errors of conformal plumbic blocks made with manual cutter and automatic cutter.Methods According to beam files of Treatment Planning System,the conformal plumbic blocks were made with manual cutter and automatic cutter respectively.Then their errors were measured.Results With manual cutter,the errors of conformal plumbic blocks were 2.355 mm.With automatic cutter,the errors of conformal plumbic blocks were 1.425 mm.Conclusion The errors of conformal plumbic blocks made with automatic cutter are less than the errors of conformal plumbic blocks made with manual cutter,so automatic cutter should be a necessary tool in making conformal plumbic blocks.

ObjectivesTo study the treatment timing and method of glucocorticoids in the treatment of abdominal type Henoch-Sch?nlein purpura (HSP).MethodsA total of 201 children with abdominal type HSP hospitalized from September 2009 to April 2013 received either conventional glucocorticoids treatment or rapid titration treatment of glucocorticoids based on the same basic therapy. According to the treatment timing and method of glucocorticoids, all patients were divided into 4 groups including early convention group (n=46), late convention group (n=44), early titration group (n=56) and late titration group (n=55). The duration from the appearance of gastrointestinal symptoms to using glucocorticoids less than or equal to three days was deifned as early treatment and more than three days was deifned as late treatment. The patients in two convention groups (early and late) were treated with methylprednisolone (2-6mg/kg per day).The patients in two titration groups (early and late) received rapid titration of methylprednisolone from an initial low dose of 2mg/kg per day to the ifnal target dose. The gastrointestinal symptoms were evaluated every 12 hours. If the gastrointestinal symptoms were not alleviated, an additional dosage of methyl-prednisolone was given. On the next day, the total dose of methylprednisolone in previous 24 hours was used as the initial dose. The dosage was increased in such a way till the gastrointestinal symptoms disappeared and this dosage was remained for 3 days. Then the dosage was gradually reduced to the maintenance dose and stopped. If the gastrointestinal symptoms were relapsed, the patients were treated again. A follow-up of 3-6 months was performed. The dosage, recurrence of symptoms and the side effects were compared among four groups.ResultsThe time of remission, target dose of glucocorticoids, total dose of glucocorticoids, recurrence rate, incidence of severe symptoms and Henoch-Schonlein purpura nephritis were signiifcantly different among four groups (P<0.05). The curative effect was best in early titration group and worst in late convention group.ConclusionsIn the treatment of abdominal type HSP, early titration treatment with glucocorticoids can signiifcantly relieve the gastrointestinal symp-toms and reduce the total dosage of glucocorticoids.

Objective To investigate the effect of JNK signal pathway in acute necrotizing pancreatitis (ANP) associated lung injury.Methods A total of 24 SD rats were randomly divided into sham group and ANP group,ANP rats were induced by retrograde injection of 5％ sodium taurocholate into common bile duct.The rats were sacrificed 12 and 24h later,and the pancreas and lung tissue were resected and underwent routine pathologic examination,ELISA method was used to detect the level of TNF-α and IL-1β in lung tissue.Expression of JNK mRNA was detected by real time PCR,and the expression of JNK protein were evaluated by Western blotting.Results There was bleeding,necrosis,large amount of inflammatory cells infiltration in pancreatic tissue; and there was edema,pulmonary consolidation,interstitial edema,inflammatory cells infihration in lung tissue in ANP group.The levels of TNF-α and IL-1β,JNK mRNA,JNK protein,phosphorylation JNK were ( 374.3 ± 124.0) pg/ml,(649.0 ± 114.9) pg/ml,2.57 ± 0.76,1.40 ± 0.81,0.81 ± 0.20 in ANP group,which were significantly higher than those in with sham group[( 218.2 ± 68.4)pg/ml,(524.3±58.4)pg/ml,1.03±0.11,0.32±0.11,0.32±0.11,P＜0.05].Conclusions JNK signal pathway plays an important role in experimental ANP associated lung injury in rats.

Objective:To evaluate the role of nuclear factor erythroid 2-related factor/ heme oxygenase-1 (Nrf2/HO-1) signaling pathway in dexmedetomidine-induced reduction of oxygen-glucose deprivation and restoration (OGD/R) injury to microglia.Methods:BV-2 microglia were cultured in high-glucose DMEM culture medium supplemented with 10% fetal bovine serum in an normal culture incubator at 37 ℃ (5%CO 2-21%O 2-74 %N 2). The cells were seeded in 96-well plates at a density of 1.5×10 4 cells/ml (200 μl/well) or 6-well plates at a density of 2×10 5 cells/ml (2 ml/well) and divided into 5 groups ( n=30 each) using a random number table method: control group (group C), dexmedetomidine group (group D), group OGD/R, OGD/R+ dexmedetomidine group (group OGD/R+ D) and OGD/R+ dexmedetomidine+ ML385 group (group OGD/R+ D+ ML). The cells in group C were continuously cultured in a normal culture incubator for 26 h. In group D, dexmedetomidine at the final concentration of 10 μmol/L was added, cells were incubated for 2 h, and then were continuously incubated in a normal culture incubator for 26 h. In OGD/R, OGD/R+ D and OGD/R+ D+ ML groups, the culture medium was replaced with glucose-free DMEM culture medium, cells were cultured for 2 h in an incubator at 37 ℃ (5%CO 2-1%O 2-94 %N 2), the culture medium was replaced with high-glucose DMEM culture medium containing 10% fetal bovine serum and then the cells were cultured for 24 h in a normal incubator.Dexmedetomidine at the final concentration of 10 μmol/L was added at 2 h before OGD in OGD/R+ D and OGD/R+ D+ ML groups.Nrf-2 inhibitor ML385 at the final concentration of 4 μmol/L was added at 30 min before dexmedetomidine was added in group OGD/R+ D+ ML.Cells in 6 wells in each group were selected randomly for assessment of cell viability (by methyl thiazolyl tetrazolium assay) and apoptosis (using flow cytometry), and for determination of the concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 in the supernatant (using enzyme-linked immunosorbent assay), the expression of Nrf2 in nucleus, Nrf2 and HO-1(by Western blot ) and the expression of HO-1 mRNA (by real-time polymerase chain reaction). Results:Compared with group C, the cell viability was significantly decreased, cell apoptosis rate and concentrations of TNF-α, IL-6 and IL-10 in the supernatant were increased, and the expression of Nrf2 in nucleus, Nrf2, HO-1 and its mRNA was up-regulated in OGD/R and OGD/R+ D groups ( P<0.05), and no significant change was found in each parameter mentioned above in group D ( P>0.05). Compared with group OGD/R, the cell viability and IL-10 in the supernatant concentration were significantly increased, cell apoptosis rate and concentrations of TNF-α and IL-6 in the supernatant were decreased and the expression of Nrf2 in nucleus, Nrf2, HO-1 and its mRNA was up-regulated in group OGD/R+ D ( P<0.05), and no significant changes were found in the parameters mentioned above in group OGD/R+ D+ ML ( P>0.05). Compared with group OGD/R+ D, the cell viability and concentration of IL-10 in the supernatant were significantly decreased, cell apoptosis rate and concentrations of TNF-α and IL-6 in the supernatant were increased and the expression of Nrf2 in nucleus, Nrf2, HO-1 and its mRNA was down-regulated in group OGD/R+ D+ ML ( P<0.05). Conclusion:The mechanism by which dexmedetomidine alleviates OGD/R injury to microglia may be related to promoting the activation of Nrf2/HO-1 signaling pathway and inhibition of inflammatory responses.

Objective To investagate the change of creatine kinase MB isoenzymes ( CK-MB ) in children with rotavirus diarrhea and to explore the value of CK-MB/CK in the diagnosis of myocardial damage. Methods A retrospective analysis of the clinical manifestation, laboratory test data and treatment was per-formed in children with rotavirus diarrhea and high CK-MB hospitalized in department of infectious disease, Si-hong Children Hospital. We investigated the dynamic changes of CK-MB in the rotavirus diarrhea patients with and without myocardial damage. Within the non-myocardial damage group, the fluctuation of CK-MB was compared between patients with nutrition therapy and patients with conventional therapy. Receiver operating characteristic ( ROC) curve was used to explore the predictive value of CK-MB/CK for the myocardial dam-age. Results A total of 603 patients (369 males, 234 females, aged 2~48 months) with high CK-MB were enrolled in this study ( 36 cases with myocardial damage ) . There were 54. 6% of enrolled patients showing higher CK-MB and 3. 3% of patients had myocardial damage. The levels of serum CK-MB in non-myocardial damage group reached the peak on day 7 and decreased to normal in 14 days. The levels of serum CK-MB in myocardial damage group reached the peak on day 14 and maintained at fairly high level for 8 weeks and then decreased to normal . Time for CK-MB to achieve peak is different between these two groups. There was no statistical significance in the levels of serum CK-MB on day1 to day 14 between patients with or without myocar-dial protection ( P >0. 05 ) . The ROC curves were constructed with area under the ROC curves of 0. 697 (0. 611, 0. 784, 95%CI). Conclusion Intrinsic dynamics of CK-MB existed in patients with rotavirus diar-rhea. The diagnostic value of CK-MB is limited in patients with myocardial damage.

Objective To evaluate the effect of neoadjuvant chemotherapy on lymph node micrometastasis and DC cell number in stage Ⅲ gastric cancer patients.Methods Lymph node micrometastases in pathologically negative lymph nodes from 76 stage Ⅲ gastric cancer patients [56 cases with neoadjavant chemotherapy (NCT) and 20 cases without],were assessed by cytokeratin-20 antibody.Dendritic cells (DC) in HE positive lymph nodes,HE negatives near tumor foci and HE negatives far foci were assessed by CD83 antibody respectively.Patients were divided into four groups:group 0 (20 cases without NCT),group 2 (two courses of NCT in 29 patients),group 3 (three courses of NCT in 16 patients),group 4 (four courses of NCT in 11 patients).Results In NCT group there were two patients with micrometastases (2/56).All the patients were with micrometastases in control group (20/20).Difference was statistically significant (P =0.000).In HE-positive lymph node group:the number of CD83-positive DC in 2 times group,3 times group,and 4 times group when compared with no chemotherapy group were statistically significant (P20 =0.001,P30 =0.000,P40 =0.000).In HE-negative lymph node near foci group:the number of CD83-positive DC in 3 times group,and 4 times group compared with 0 group were statistically significant increased (P30 =0.001,P40 =0.001).In HE-negative lymph node far foci group:the number of 4 times group was significantly higher than 0,2 and 3 group (P40 =0.000,P42 =0.000,P43 =0.001).Conclusions Neoadjuvant chemotherapy is effective in the prevention of lymph node micrometastases in stage Ⅲ gastric carcinoma and it increases the number of mature dendritic cells in lymph nodes.

Objective To study the dynamic variation of mbisoenzyme of creatine kinase(CK-MB) in the infected course of respiratory syncytial virus and explore the value of CK-MB/CK in the diagnosis of myocardial damage.Methods A total of 577 pediatric patients (317 males,260 females,aged 2 ～ 18 months) with CK-MB/CK ＞5％ from 2010 to 2013 were enrolled in this study (44 complicated by myocardial damage).Five hundred and thirty-three patients with high values CK-MB simply were randomly divided into treatment group (n =243) and control group(n =290).The dynamic variation of CK-MB were investigated.The diagnosis analyzed by receiver operating characteristic (ROC)curve was used to explore the predictive value of differential diagnosis between the pediatric patients with myocardial damage and without myocardial damage.Results Approximately 46.5％ of cases with rotavirus diarrhea had higher CK-MB and 3.5％ of cases had myocardial damage.The time of CK-MB achieved peak and anomalous duration was different between the cases with myocardial damage and without myocardial damage.There was no statistical significance between the cases with or without protecting myocardial(P ＞ 0.05).The ROC curves were constructed with area under the ROC curves of 0.663 (95 ％ CI 0.578,0.747).Conclusion The blood levels of CK-MB in children with respiratory syncytial virus infection existed obvious dynamic variety,which contributed little value to the diagnosis of myocardial damage.

Objective To investigate the clinical effect of Kangfuxin liquid topical treatment for open wound of perianal abscess.MethodsEighty patients with open wound were treated with perianal abscess from June 2015 to June 2016.The patients were divided into two groups according to their treatment group.Patients were treated with conventional regimen, while 40 patients in the observation group were treated with routine regimen+rehabilitation solution;the experimental data were compared between the two groups.The two groups were observed and compared the wound healing time (d), granulation growth cycle (d) and healing rate (%);the two groups were observed and compared the incision pain, edema, anal bulge and other symptoms disappeared time;compared two groups of clinical curative effect and complication rate.ResultsThe clinical treatment effect of the observation group was better than that of the control group, the difference was statistically significant (P<0.05).ConclusionThe clinical effect of the treatment of open wound in patients with perianal abscess with conventional therapy+rehabilitation therapy is significant, and the wound healing time is short, which is widely used in the treatment of open wound of perianal abscess.

Objective To compare patellar ring,Kirschner wire tension band and patellar ring plus Kirschner wire in fixation for treatment of patella fractures.Methods A retrospective analysis was conducted on the 285 patients with patellar fracture who had been treated between September 2009 and January 2016.They were 155 men and 130 women,with an average age of 45.5 years (from 18 to 70 years).Their fractures included 176 transverse,28 longitudinal split and 81 comminuted ones.They were divided into 3 groups according to their different internal fixation methods:patellar ring fixation (98 cases),Kirschner wire tension band (92 cases),patellar ring plus Kirschner wire fixation (95 cases).The 3 groups were compared in terms of operative time,intraoperative bleeding,fracture healing time,knee function by B(o)stman score at the last follow-up and postoperative complications.Results The operative time in the patellar ring group(58.9 ±6.4 min) was significantly shorter than in the Kirschner wire group (71.8 ± 7.8 min) and in the patellar ring plus Kirschner wire group (74.4 ± 8.0 min) (P ＜ 0.05).There were no statistical significant differences between the 3 groups in fracture healing time and intraoperative bleeding (P ＞ 0.05).The good to excellent rate of knee function at the last follow-up in the Kirschner wire tension band group was 100.0％ (92/92),significantly higher than in the patellar ring group (90.8％,89/98) and in the patellar ring plus Kirschner wire group (91.6％,87/95) (P ＜ 0.017).There was no significant difference in postoperative complication rate between the patellar ring fixation group (2.0％,2/98),Kirschner wire tension band fixation group (1.1％,1/92) and the patellar ring plus Kirschner wire group (2.1％,2/95) (P ＞ 0.05).Conclusion Internal fixation with Kirschner wire tension band has definite curative effect on patellar fractures,showing the advantages of less operative invasion,fewer postoperative complications,better functional recovery of the affected knee joint,and lower price over the other 2 internal fixation methods.

Objective To investigate the prognostic value of preoperative neutrophil lymphocyte ratio (NLR) in patients with gastrointestinal stromal tumors (GIST).Methods The clinical-pathological data from 85 GIST cases were collected from the Second Affiliated Hospital of Wenzhou Medical University and retrospectively analyzed from June 2009 to December 2013.According to the exclusion criteria,79 cases were enrolled.Preoperative neutrophil and lymphocyte count was collected and NLR was calculated.According to the receiver operating characteristic (ROC) curve of NLR,GIST patients were divided into low NLR group (NLR ＜ 2.30) and high NLR group (NLR ≥ 2.30).Clinic-pathological features and five year disease free survival (DFS) were compared between the two groups.Results There was a statistical significant difference in tumor size and tumor risk between high NLR group and low NLR group (respectively,x2 =9.517,12.411,all P ＜ 0.05).Univariate analysis showed that the five year disease free survival rate of low NLR and high NLR group were 78％ and 32％ (x2 =18.749,P =0.000).By multivariate analysis a high NLR was identified as an independent risk factor of poorer prognosis for patients with GISTs (RR:3.516,95％CI:1.453-8.506,P=0.005).Conclusion A high preoperative NLR is an independent risk factor for the prognosis of GISTs.