Objective:To provide better clinical treatment plan by grading and classifying four-dimensional ultrasound pelvic floor dynamic imaging primiparas pelvic floor dysfunction.Methods: 270 cases with pelvic floor functional disorders (bladder prolapse) of high-risk mothers were selected, from the beginning of the median sagittal plane and three-dimensional reconstruction of the surface at rest, to observe the bladder and urethra and pelvic diaphragm hiatus and anal status under Valaslva changes in the measurement parameters (bladder neck mobility, posterior horn of bladder and urethra, rotation angle of the urethra) and its Green typing.Results: There was no statistical difference between the mode of delivery cystocele resting corresponding BSD and posterior horn of bladder and urethra (t=1.133,t=1.165;P>0.05). Under Valsalva state, there were significant differences the two groups corresponding to BSD, the bladder neck mobility, posterior horn of bladder and urethra and rotation angle of the urethra (t=2.147,t=5.628,t=3.502,t=4.396;P<0.05). The incidence rate of type II and type III in vaginal delivery group is higher than that in cesarean section group. The incidence rate of type I in vaginal delivery group is less than that in cesarean section group. The differences were statistically significant (x2=6.080,P<0.05). Conclusion: The pelvic floor dynamic four-dimensional ultrasound imaging can clearly show the situation of pelvic floor before primiparas to understand the situation of maternal mode of delivery cystocele production. It can provide a more reliable basis for early clinical diagnosis of maternal pelvic floor dysfunction.

Objective:To use the perineum four-dimensional pelvic ultrasound stereo imaging for detecting injury situation of pelvic diaphragm hiatus and anal levator ani muscle. Understand abnormal classification of pelvic floor muscle. investigate the application of four-dimensional pelvic ultrasound stereo imaging in pelvic floor dysfunction (PFD) for primipara in order to provide more accurate data for clinical practice.Methods: 270 primiparas with pelvic floor dysfunction were divided into the vaginal delivery group (135 cases) and selective cesarean group (135 cases) as random number table; pelvic floor muscle strength, longitudinal diameter, transverse diameter, area of pelvic diaphragm hiatus and thickness of the anus levator were detected by the perineum four-dimensional pelvic ultrasound stereo imaging, respectively, and then to compare differences between the two groups. Results: In 270 cases, 162 cases (60%) were abnormalities in pelvic floor muscle strength, and 189 cases (70%) were abnormalities in vaginal pressure; the results of pelvic floor muscles fatigue grade situation revealed: 127 cases were abnormal muscle fiber strength ofⅠtype (47%), 30 patients were abnormal muscle fiber strength ofⅡ type (11%). There were no significant differences between the two groups in the abnormal rate of pelvic floor muscle strength, vaginal pressure and muscle fiber strength. Longitudinal diameter, transverse diameter and area of pelvic diaphragm hiatus in the vaginal delivery group were higher than that in the selective cesarean group, while thickness of anal levator were thinner than that in the selective cesarean group with significant differences (t=3.730,t=3.467, t=3.826,t=1.809;P<0.05).Conclusions: The perineum four-dimensional ultrasound diagnosis can intuitively and clearly show morphological characteristics of female pelvic diaphragm hiatus, therefore, it can quickly finish diagnosis, and provide the basis for clinical diagnosis and treatment evaluation of postpartum PFD.

Objective To study the effect of pulsing magnetic field (PMF) on the osteogenesis of the distracted region in cosmetic limb lengthening, and to search for an effective therapeutic method for promoting the recovery of the cosmetic patient. Methods Thirty adult short stature volunteers for cosmetic heightening were randomly divided into PMF group and control group, 15 in each group. Magnetic stimulation was given to the PMF group on the day after operation. X-ray examination was taken on fixed interval, and lengthening index was used for bone healing evaluation. Results The height increase ranged from 5～9 cm, mean (6.6?1.2) cm, and the mean lengthening rate was 19.2 % : 5～8 cm (6.2?1.1) cm in the PMF group and 5.2～9 cm (6.8?1.6)cm in the control group ( P

Objective To study the accuracy of SentinelTM system for patient setup using rigid-body phantom.Methods A 002LFC IMRT phantom was placed on Elekta HexaPODTM 6-degree couch using tattoo and the laser in the treatment room.When a well-know shift (3 directions) and rotation (3 positions) was moved,CBCT and SentinelTM system were scanned respectively,and the measuring errors of six dimensions were recorded.The absolute differences between applied and measured errors were compared and paired t-test.Results Total 15 well-know shifts were investigated.The SentinelTM system was very good stability and the largest absolute difference only 0.9 mm (z direction) and 0.2° (arbitrary direction).At the same time,a good conformance between SentinelTM system and CBCT was displayed because the largest absolute difference between applied and measuring error was less than 0.9 mm (z direction) and 0.2° (arbitrary direction).Conclusions SentinelTM system is fast,simple,non-invasive and seems to be reliable in detecting patient setup errors.It maybe hold potential to ensure precise patient positioning with reduced CBCT frequency in tumor locations with fixed relation to surface structures.

Objective To improve the awareness,diagnosis and treatment of pneumocystis carinii pneumonia (PCP) after renal transplantation.Methods A retrospective review was performed in 28 patients who underwent renal transplantation and developed PCP afterwards.The main clinical manifestations were fever(28 cases),nonproductive cough(28 cases),chest distress (12 cases).Occurrences of PCP were described 1.5 to 7 months after the renal transplantation.There were 10 patients treated with tacrolimus (FK506 2-6 rag/d,FK506 concentration 4-10 ng/ml) and 18 patients treated with cyclosporine (CsA 200-500 mg/d,CsA trough level:150-250 ng/ml) based immunosuppressive regimen.Anti-CD_(25)~+ monoclonal antibody (anti-CDCD_(25)~+mAb) was used in 10 cases for immune induction before operation while single steroid in 18 cases.Creatinine of patients with PCP was 70 to 106 μmol/L.CD_4~+ lymphocyte counts of the peripheral blood were 245±32/μl before PCP treatment and 536±25/μl after recovery.The most abnormal chest radiological findings were bilateral patchy ground-glass opacity.All the patients were diagnosed with PCP by bronchoalveolar lavage.Treatment was performed by reducing immunosuppressive agents and giving SMZco.Nineteen patients who had a PaP2 less than 70 mm Hg were given intravenous small-dose steroid.Results All the patients recovered from PCP 2 to 3 weeks after treatment.One patient experienced recurrence half year later.Five patients with higher creatinine after treatment recovered to normal levels after stopping the treatment of SMZco.No significant differences were seen in PCP patients treated with CsA and FK506,P＞0.05.The similar results were observed in use of anti-CDCD_(25)~+ mAb and single steroid,P＞0.05.Significant differences were observed in PCP patient peripheral blood CD_4~+ lymphocyte counts before and after treatment (P=0.001).Conclusions Patients who have fever,cough and hypoxia,chest imaging showing bilateral lung interstitial inflammation,might be PCP patients in the early post-renal transplantation period.Effective treatment should be performed by reducing immunosuppressive agents and giving SMZco.

Objective To observe the clinical efficacy of comprehensive acupuncture therapy in treating tinnitus in elderly neurosensory deafness. Method Eighty elderly neurosensory deafness patients were randomized into a treatment group and a control group, 40 cases in each group. The control group was intervened by oral administration of Mecobalamin tablets, and the treatment group was intervened by acupuncture plus acupoint injection plus auricular point sticking. The changes of tinnitus intensity after the treatment in the two groups were observed, the clinical efficacies were compared between the two groups, and the correlation between disease duration and therapeutic efficacy was also observed. Result The tinnitus degree was significantly changed after the treatment in both groups (P<0.01). The total effective rate was 83.3% in the treatment group, versus 57.1% in the control group. There was a significant difference in comparing the clinical efficacy between the two groups (P<0.05). In both groups, the clinical efficacy of the patients with a disease duration ≤3 years was significantly different from that of the patients with a disease duration > 3 years in the same groups (P <0.05). Conclusion Comprehensive acupuncture therapy is an effective method in improving tinnitus in elderly neurosensory deafness.

Objective To investigate the effects of hippocampal?sparing intensity?modulated radiotherapy ( IMRT) on dose distribution of target volume and organs at risk ( OARs) in locally advanced nasopharyngeal carcinoma. Methods A retrospective dosimetric analysis was performed among 11 patients with locally advanced nasopharyngeal carcinoma. The MONACO ? v5. 10 Treatment Planning System was used to design three treatment plans:routine volumetric modulated arc therapy ( VMAT ) , hippocampal?sparing VMAT, and nine fixed?fields IMRT. The D98%, D50%, D2%, Dmean , conformity index ( CI ) , and homogeneity index (HI) of planning target volume (PTV) and PTVnx as well as dose distribution of the hippocampus and OARs were evaluated. Using single factor analysis of variance,two group comparative was LSD or paired t?test. Results For the above three plans,the D2% values of PTVnx were ,7 513,and 7 462 cGy,respectively (P=0. 016);the D98% values of PTV were 5837,5812,and 5914 cGy,respectively (P=0. 029);the average D2% values of PTV were 7 399,7 380,and 7 333 cGy,respectively ( P=0. 047);the HI values of PTV were 0. 239,0. 241,and 0. 220,respectively (P=0. 016);the V10 values of the brain stem were 97. 2%,88. 1%,and 90. 3%,respectively ( P=0. 001);the V20 values of the brain stem were 74. 2%, 62. 3%,and 67. 1%,respectively ( P=0. 032);the V30 values of the brain stem were 50. 9%,35. 8%,and 45. 5%, respectively ( P= 0. 020 );the V40 values of brain stem were 24. 4%, 14. 4%, and 23. 3%, respectively ( P=0. 018);the Dmean values of hippocampus were 1 518,899,and 896 cGy,respectively ( P=0. 000);the D40% values of hippocampus were 1 379,642,and 639 cGy,respectively ( P=0. 000);the V10 values of the hippocampus were 54. 1%,25. 1%,and 3. 8%,respectively ( P=0. 000);the V20 values of the hippocampus were 26. 2%, 12. 6%, and 12. 0%, respectively ( P=0. 001 ) . Conclusions Hippocampal?sparing VMAT and nine fixed?fields IMRT can significantly reduce the dose to the hippocampus without affecting dose distribution of target volume and OARs. VMAT may be superior to IMRT because VMAT can simultaneously reduce the dose to the brain stem.

Objective To investigate the feasibility of prophylactic cranial irradiation with hippocampal avoidance (HA-PCI) in non-small cell lung cancer (NSCLC).Methods The clinical data of 56 patients with brain metastases of NSCLC who were treated from 2011 to 2014 were collected.Brain metastases and the hippocampus were delineated on T1 W1 contrast-enhanced MRI,and the distance between brain metastases and the hippocampus was analyzed;an HA-PCI regimen was also developed,and the distribution of the metastases in planning target volume (PTV) low-dose regions around the hippocampus was analyzed.Results None of the 139 metastases involved the hippocampus.There were 6(4.3％) and 18 (12.9％) metastases within 5 mm and 10 mm,respectively,outside the hippocampus.In the HA-PCI regimen,the D50％ and D2％ of PTV were 25.6 Gy and 27.1 Gy,respectively.Dmean and D2％ for the hippocampus were 7.4 Gy and 9.9 Gy,respectively;D50％ within 0-5.0 mm,5.1-10.0 mm,and 10.1-15.0 mm outside the hippocampus was 10.3 Gy,15.1 Gy,and 20.5 Gy,respectively.Conclusions HA-PCI may be feasible theoretically,but this needs to be confirmed by the intracranial failure pattern in patients with long-term survival.

[ ABSTRACT] AIM:To investigate the effects of microRNA-378*( miR-378*) on the survival and apoptosis of human mesenchymal stem cells ( hMSCs ) .METHODS: The expression of miR-378* was determined by microRNA arrays and quantitative real-time PCR ( qRT-PCR) .H2 O2 was used to induce hMSCs apoptosis.By transfection of miR-378*mimic or inhibitor, we up-regulated or down-regulated miR-378* expression in hMSCs.The effect of miR-378*and connective tissue growth factor ( CTGF) on hMSC survival and apoptosis were detected by MTT, LDH, caspase-3/7 and TUNEL assays.RESULTS:The expression of miR-378*was up-regulated in the old hMSCs compared with the young hMSCs.H2 O2 increased the expression of miR-378*, decreased the expression of CTGF.Up-regulation of miR-378*re-sulted in increasing apoptosis and decreasing survival of hMSCs.Conversely, down-regulation of miR-378*resulted in de-creasing cell apoptosis and increasing survival.The regulation of miR-378*on hMSC apoptosis and survival was attenuated by inhibiting the expression of miR-378* and CTGF together.Direct repression of CTGF expression inhibited the hMSC survival and increased apoptosis.CONCLUSION:miR-378*enhances apoptosis of hMSCs by repressing the expression of CTGF.

Objective:To investigate the relationship between clinical effects of acupuncture for elderly patients with sensorineural deafness and ear distending sensation.Methods:A total of 120 elderly patients with sensorineural deafness were randomly divided into a comprehensive treatment group,an acupuncture group and a Western medicine group,with 40 cases in each group.The acupuncture group received acupuncture treatment,the Western medicine group received oral mecobalamin tablets and the comprehensive treatment group received acupuncture plus acupoint injection and auricular acupoint sticking.The values of pure tone hearing threshold test of the three groups were observed before and after treatment,and the relationship between clinical effects and ear distending sensation was compared.Results:The total effective rate of the comprehensive treatment group was 82.5％ versus 67.0％ in the acupuncture group and 62.5％ in the Western medicine group.The inter-group comparisons showed statistically significant differences in the comprehensive treatment group versus the Western medicine group (P＜0.01) and the acupuncture group (P＜0.05).In the comprehensive treatment group,there were 23 cases (57.5％) with ear distending sensation,the clinical total effective rate was 86.9％;there were 17 cases (42.5％) without the sensation,the clinical total effective rate was 76.5％.In the acupuncture group,there were 24 cases (60.0％) with ear distending sensation,the clinical total effective rate was 71.0％;there were 16 cases (40.0％) without the sensation,the clinical total effective rate was 63.0％.In the Western medicine group,there were 21 cases (52.5％) with ear distending sensation,the clinical total effective rate was 66.7％;there were 19 cases (47.5％) without the sensation,the clinical total effective rate was 57.9％.The total effective rate of patients with ear distending sensation were higher than the rates of those without ear distending sensation in the three groups,but the differences were insignificant (all P＞0.05).Conclusion:The comprehensive therapy is one of the effective methods to treat elderly patients with sensorineural deafness.In the three groups of elderly patients with sensorineural deafness,the relief of ear distending sensation and the hearing loss were basically simultaneous,and the hearing recovery in the patients with ear distending sensation may be slightly better than that in those without ear distending sensation.Nevertheless,further research is needed.