Objective To perform a systematic review and Meta-analysis on volumetric and dosimetric changes in target volumes and organs at risk (OARs) in adaptive radiotherapy (ART) for patients with head and neck cancer (HNC),and to investigate the role of ART in the treatment of HNC.Methods Literature retrieval was performed to include related studies,and the parameters of primary tumor,GTV-T and GTV-N,parotid volume,D95 and Dmean of target volumes,Dmean of ipsilateral and contralateral parotid volume (I-PG and C-PG),and Dmax of the spinal cord and brainstem.Results A total of 17 studies involving 336 patients were included in the meta-analysis.Primary tumor and parotid volume changed significantly.The volumes of GTV-T,GTV-N,and I-PG were significantly reduced during the 15-20th radiotherapy and after the 20th radiotherapy (P＜0.05),and the C-PG was significantly reduced after the 20th radiotherapy (P=0.004).The analysis of actual dose showed that the D95 and Dmean of primary tumor showed no significant differences,and during the 15-20th radiotherapy,the Dmax of the spinal cord was increased by 2.26 Gy (P=0.000),while the Dmax of the brainstem showed no significant changes before the 20th radiotherapy and was increased by 1.78 Gy after the 25th radiotherapy (P=0.020).In addition,the Dmean of I-PG was increased by 2 Gy during the 20-25th radiotherapy (P =0.0001),and the D of C-PG was increased before the 20th radiotherapy and showed no significant changes after the 25thradiotherapy (P=0.110).The dosimetric analysis of ART showed that the Dmax of the spinal cord and brainstem was reduced significantly (spinal cord:MD =-2.15,95％ CI-3.12 to-1.18,P=0.000;brainstem:MD =-2.20,95％ CI-3.32 to-1.09,P=0.000).The Dmean of I-PG was reduced by about 3.5 Gy,and the sensitivity analysis revealed that the results of Dmean of C-PG were unstable.Conclusions The volumes of primary tumors and parotid glands change significantly,and the actual doses of OARs (Dmax of the spinal cord and brainstem and Dmean of the parotid glands) significantly increase,while the doses of GTV-T and GTV-N show no significant changes.ART can effectively protect the OARs,and patients with locally advanced HNC who receive concurrent chemoradiotherapy can obtain good dose gains from ART plan performed during the 15-20th radiotherapy and at about the 25th radiotherapy.

Objective To compare the effects of positioning robustness on dose distribution between intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for head and neck tumor,and to evaluate their needs for image-based guidance.Methods Thirty patients with nasopharyngeal carcinoma undergoing IMRT were enrolled as subjects.The VMAT plans were designed according to the clinical dosimetric requirements and the dose calculation was made by the AAA method.For the two plans in each patient,the isocenters were shifted by ±1.0,±3.0,and ±5.0 mm along the original x,y,and z axes to simulate the impacts of positioning errors in left-right (LR),superior-inferior (SI),and anterior-posterior (AP) directions,respectively,on dose distribution.The dose-volume histogram parameters were analyzed in 60 references and 1080 re-calculated plans.Comparison was made by paired t-test.Results When the error was 1 mm,the average deviations of gross tumor volume (GTV) D98,clinical target volume (CTV) D95 and heterogeneity index,and planning gross tumor volume (PGTV) V95 were＜0.5％.When the error was 3 mm,the average dose deviations of GTV and CTV were＜1.0％ and significantly larger in VMAT than in IMRT;the average dose deviation of PGTV was large (GTV D98,P=0.00;CTV D95,P=0.00);the average deviations of PGTVnxV95 and PGTVndV95 were significantly smaller in IMRT than in VMAT (1.64％vs.1.95％,P=0.01;1.73％ vs.2.63％,P=0.00).The deviations of parameters became larger with the increasing positioning error and were significantly larger in VMAT than in IMRT (GTV D98,P=0.00;CTV D95,P=0.00;CTV HI;P=0.00;PGTV V95;P=0.01).Compared with the target volume,Dmax to the spinal cord and brain stem had larger deviations.However,there were no significant differences in Dmax to the spinal cord and brain stem between IMRT and VMAT.Conclusions The IMRT and VMAT plans are both robust when the positioning error is small (＜3 mm).Compared with IMRT,VAMT is more sensitive to the positioning error,mainly in the target volume.The difference between the two plans becomes larger with the increasing positioning error.An increase in the frequency of image-based guidance is recommended for patients undergoing VMAT.

Objective To determine the dangerous depths of acupuncture at Yamen(GV15) and Fengfu(GV16) in different age groups and different body types based on MRI measurements and to analyze their distribution chracteristic .Methods 98 patients of different age groups in the affiliated hospital of Hainan Medical College from June to December 2012 were selected and the each age group was divided into 3 types :asthenic type ,moderate type and endomorphy type according to the Rohrer index .All images took the median sagittal position .The dangerous depth was measured according to the clinical operation habit and actual feasibility .Re-sults The difference in the acupuncture depth of GV15 and GV16 among different asthenic type patients in different age groups had no statistical significance ;in the moderate type patients ,the difference in the acupuncture depth of GV15 and GV16 between the age group of 18- <45 years and 45-60 years had the statistical significance(P=0 .029 ,P=0 .018);in the endomorphy type pa-tients ,the difference in the acupuncture depth of GV15 and GV16 between the age group of 45-60 years and the other age groups had the statistical significance(P<0 .05) .Conclusion The dangerous depth of GV15 and GV16 had no correlation with age ,but is positively correlated with the Rohrer index ,i .e .,the dangerous depth of GV15 and GV16 is increased with the increase of Rohrer index .

Objective To investigate the clinical and epidemiological characteristics of pulmonary thromboembolism (PTE) and deep venous thrombosis (DVT). Methods The clinical data of 114 200 inpatients from June 2002 to June 2008, including gender, age, smoking history, primary disease and risk factors, were reviewed. Results There were 1445(1.27%) cases with venous thromboembolism (VTE), while 1433(1. 25%) patients suffered from DVT and 153(0. 13%) patients suffered from PTE, 16(11. 11 %) patients were dead of PTE. Of all the DVT patients, there were 1348(94. 1%) cases with DVT of lower limbs with no significant difference between left or right lower limb (P>0. 05). There were 49(3.4%) cases with inferior vena cava, 23(1.6%) cases with cavitas pelvis veins and 13(0. 9%) cases with upper extremity veins. The peak ages of morbidity were between 51 to 60 years. Conclusions The incidence of VTE is increasing with ageing and there is no significant difference between males and females. The most common risk factors for thromboembolism include trauma, surgery, cardiac and pulmonary disease, age over 50 years, deep phlebitis, long-term smoking, cancer, pregnancy, childbirth, braking, history of VTE, etc. We may lower the incidence and mortality of VTE by strengthening prevention work according to the high risk factors.

Objective To investigate the dosimetric comparison of target volumes and organs at risk (OAR) between volumetric-modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) for esophageal cancer by a meta-analysis.Methods A literature search was performed to collect the clinical studies on dosimetric comparison between VMAT and IMRT.The primary endpoints of interest were dosimetric parameters of target volumes and OAR, number of monitor units (MUs), and treatment time (TT).Results A total of 17 studies involving 323 patients were included in this meta-analysis.When the total dose was>50.4 Gy, VMAT showed significantly lower mean dose (Dmean) of gross tumor volume (GTV) and maximum dose (Dmax) of planning target volume (PTV) than IMRT (P=0.009;P=0.039).There were no significant differences in Dmean, V30, and V40 of the heart, Dmax of the spinal cord, and V5, V10, and Dmean of the lung between VMAT and IMRT (P>0.05).VMAT showed significantly lower V15, V20, and V30 of the lung than IMRT (P=0.001;P=0.000;P=0.023).When the single dose was 1.8 Gy and 2.0 Gy, VMAT showed significantly lower TT (reduced by 323.5 s and 193.7 s) and number of MUs (reduced by 275.4 MU and 134.2 MU) than IMRT (P=0.000 and 0.009;P=0.000 and 0.022).Conclusions VMAT can significantly reduce TT, MUs, irradiation dose to the lung, and the risk of radiation pneumonitis, and improve the utilization rate of equipment.Compared with IMRT, VMAT has no significant advantages in protection of the spinal cord and the heart and dosimetric parameters of target volumes except Dmean of PTV and Dmean and Dmax of GTV when the total dose was ≤50.4 Gy.

Objective To compare open versus closed reduction in treatment of children with displaced femoral neck fracture whose reduction is delayed by more than 24 hours.Methods We retrospectively reviewed 51 children who had been treated at our department for femoral neck fracture between May 2005 and May 2012 after their reduction had been delayed for more than 24 hours.They were 37 boys and 14 girls,1.7 to 15.5 years of age (average,9.1 years).According to Delbet's classification,27 cases belonged to type Ⅱ,18 to type Ⅲ,and 6 to type Ⅳ.Of them,18 underwent closed reduction and 33 open reduction.Their complications were recorded in detail.Their therapeutic results were evaluated according to Ratliff's criteria and compared between the 2 methods of reduction.Results The 51 children were followed up for an average of 36.7 months (range,from 17 to 61 months).Anatomic reduction was achieved in 6 cases in the closed reduction group (33.3％) and 29 cases in the open reduction group (87.9％),respectively.All fractures healed after an average of 10.9 weeks (range,from 9 to 13 weeks),with one exception of nonunion in the closed reduction group.The incidence of femoral head necrosis in the closed reduction group (27.8％,5/18) was significantly higher than that in the open reduction group (15.2％,5/33) (P ＜ 0.05).According to the Ratliff's evaluation at the final follow-ups,the good to excellent rate in the closed reduction group(66.7％,12/18) was significantly lower than that in the open reduction group (84.8％,28/33) (P ＜0.05).Coxa vara occurred in 3 children in the closed reduction group but in none in the open reduction group.Conclusion Open reduction with internal fixation may lead to better outcomes than closed reduction in the treatment of children with displaced femoral neck fracture whose reduction is delayed by more than 24 hours,probably because open reduction can result in better reduction quality.

This study was aimed to observe influence on clinical symptoms of Qing-Fei Pei-Yuan Wei-Wan (QFPY-WW) for pulmonary infection HIV/AIDS cases with the syndrome of phlegm-heat obstructing the lung. A total of 141 pulmonary infection HIV/AIDS cases with the syndrome of phlegm-heat obstructing the lung were randomly divided into the treatment group (94 cases) and the control group (47 cases). The treatment group was given basic western medication combined with QFPYWW. The control group was given basic western medication. After 4 weeks treat-ment, observation was made on changes of main symptoms. The results showed that on the 28th day, compared with the control group, there was improvement on symptoms such as cough, breathing and chest tightness (P< 0.05). Com-parison on coughing up phlegm degree showed that the treatment group was significantly better than the control group (P< 0.05). On the 7th day treatment, the treatment group had better effect on lowering body temperature than the control group (P< 0.05). It was concluded that QFPYWW can improve symptoms such as cough, breathing, chest tightness and cough up phlegm among pulmonary infection HIV/AIDS patients.

Objective To compare the treatment effect between Duply combined with Duckett and Koyanagi surgical methods in severe hypospadias.Methods Forty-two cases of severe hypospadias were divided into two groups according to the surgical method,23 cases was enrolled in Duply combined with Duckett group while 19 cases in Koyanagi group.The operation time,the incidence rate of urinary fistula,urethral stricture,urethral diverticulum and penis torsion were compared.Results The operation time between two groups had no significant difference (P ＞ 0.05).The incidence rate of urinary fistula,urethral stricture,urethral diverticulum and penis torsion between two groups had no significant difference (x2 =0.04,0.31,0.03,1.16,P ＞ 0.05).The total incidence rate of complications between Duply combined with Duckett group and Koyanagi group had significant difference [69.6％ (16/23) vs.6/19] (x2 =4.59,P ＜ 0.05).Conclusion Each of the two methods can be a choice in treatment of severe hypospadias.

Objective:To explore the clinical measurements for preventing and curing epistaxis in patients irradiated for nasopharyngeal carcinoma by analyzing the related factors. Methods:Thirty patients irradiated for nasopharyngeal carcinoma and consequently presented epistaxis were retrospectively reviewed by analyzing the clinical characteristics and measurements. Literature review was also performed. Results:Twenty-two cases were successfully rescued, and eight cases died (mortality rate:26.6%). Twenty-five cases underwent inflation sponge packing hemostasis, whereas three cases underwent endoscopic hemostasis with cauterization. Five patients underwent digital subtraction angiography (DSA) and selective arterial embolization. For patients who underwent one irradiation course, the epistaxis latent period ranged from 3 to 12 years, and the amount of bleeding ranged from 200 mL to 1 200 mL. For patients who underwent more than one irradiation course, the epistaxis latent period ranged from 6 months to 3 years, and the amount of bleeding ranged from 300 mL to 8 000 mL. Conclusion:Packing through choanal atresia by using inflation sponge, cautery under endoscopy, DSA, and selective arterial embolization are useful and effective measurements for hemostasis. The epistaxis latent period and volume are related to the age, tumor stage, and ir-radiation course of the patients. Patients with advanced age, tumor stage, and more than one irradiation course have short latent period and high amount of bleeding.

Objective To characterize the molecular characteristics of hemagglutinin (HA) and neuraminidase (NA) of influenza B viruses isolated in Jiangsu province,2011.Methods Thirteen strains of influenza B virus in different areas and epidemic period in Jiangsu province,2011 were selected for whole-genome sequencing,and analysis of molecule epidemic characteristics for HA and NA was carried out by bioinformatics method.Results Of the 13 randomly selected influeuza B strains,10 strains were assorted to Victoria lineage strains with NA genes from Yamagata lineage,and 3 strains belong to Yamagata lineage.Compared nucleotide and amino acid sequences of HA and NA genes with their vaccine strains respectiuely,196/197 glycosylation site appeared on HA1 gene in Yamagata/Victoria isolates virus.Conclusion Both B/Victoria and B/Yamagata lineage viruses co-circulated in Jiangsu province,and reassortant virus of Victoria lineage were predominant virus.