Objective To ascertain the dose levels to personnel from the activation products in the radiotherapy place of a proton acceterator and to provide technical basis for protection design of the treatment place and the personnel's radiation protection.Methods A PROTEUS 235 proton therapy system was analyzed for the potentials to produce activated nuclides in the air during its operation.The concentrations of the main radionuclides and the resultant personnel doses were estimated.Results The activity concentrations of activated nuclides were 15O 4.1 × 10-2,13N 3.3 × 10-2,41 Ar 6.2 × 10-3 and 11 C 2.0 × 10-2 Bq · cm-3,respectively,in proton accelerator hall,whereas those in the proton beam radiotherapy room were only about 5％ of the corresponding values in the proton accelerator hall.The annual doses to the radiation workers from immersion external exposure due to air activation were less than 1 and 0.1 mSv,respectively,when entering the proton accelerator hall 5 and 30 min after beam stopping;whereas those were 1.3-2.0,0.7-1.2 and 0.3-0.6 mSv,respectively,when entering the therapy hall 0,5 and 15 min after beam stopping.Conclusions The personnel doses received from activated nuclides in the air in the radiotherapy place of a proton acceterator are unignorable.The contribution to doses from immersed external exposure of 15O,13N,41Ar and 11C should be taken into full considerations,with necessary protection measures needed.

Objective To compare the advantages and disadvantages of high intensity focused ultrasound (HIFU ) and total abdominal hysterectomy for the treatment of uterine fibroids .Methods 167 patients with symptomatic uterine fibroids were divid‐ed into the HIFU treatment group(n=86) and the hysterectomy group(n=81) .The adverse events were recorded before operation and at postoperative 1 ,3 ,6 months .The questionnaire survey of the uterine fibroid symptoms‐quality of life (UFS‐QOL) was con‐ducted .The health related living quality was evaluated by using the health survey questionnaire‐36(SF‐36) .Results There were no severe adverse events in either group .The significant clinical complications and adverse events in the HIFU group were lower than those in the hysterectomy group .The UFS‐QOL scores in the HIFU group were superior to those in the hysterectomy group ,but the SF‐36 scores at postopertive 3 ,6 months had statistically significant differences between the two groups (P>0 .05) .Conclusion The patients who are unable to tolerate surgery or hope to preserve the uterus and its physiological function are suitable for HI‐FU treatment .

Objective To evaluate the effect of contrast-enhanced ultrasound(CEUS) in the real-time monitoring treatment of ultrasound-guided high intensity focused ultrasound (HIFU ) for uterine adenomyosis .Methods From January 2013 to September 2013 ,a total of 67 patients who were clinically diagnosticated as uterine adenomyosis were enrolled in this study .49 patients were diffuse type and 18 patients were localized .CEUS was used before ,in ,after ultrasonic treatment to make sure lesions and evaluate the ablation effect .Results 67 patients were 100% perfused before HIFU treatment by CEUS ,the non-perfused volume ratio of 15 patients(22 .4% ) were not enough during treatment ,and more energy were given .During HIFU treatment ,uniform grey scale change was observed in 42 of 67(62 .7% ) patients and massive grey scale change was observed in 25 of 67(37 .3% ) patients .The margin of targets and the non-perfused volume were clearly detected by CEUS .The size of target andymyosis ,the volume ,the non-perfused volume ,and non-perfused volume ratio were(4 .8 ± 1 .5)cm ,(63 .1 ± 57 .2)cm3 ,(59 .1 ± 53 .4 )cm3 ,(76 .4 ± 27 .0)% .The adverse effects occurred in the treatment were not related to CEUS .Conclusion CEUS is an accurate method in assessing the treat-ment effect of HIFU and could be safely used during HIFU treatment for uterine adenomyosis .

Background:For patients with liver cirrhosis and acute decompensation(AD),it is of great clinical importance to predict short-term mortality at admission. It has been reported that CLIF-C OF,MELD and MELD-Na score can accurately predict the short-term mortality,but all these scoring systems are complicated and have limits in their application. Aims:To define a simple and objective scoring system -- simplified MELD score for short-term mortality prediction in HBV-related cirrhotic patients with AD. Methods:A total of 890 consecutive HBV-related cirrhotic patients with AD hospitalized during Jan. 2005 to Dec. 2010 at Shanghai Ren Ji Hospital were enrolled retrospectively. Clinical data and patients’outcome were collected,and simplified MELD score was calculated by using total bilirubin,international normalized ratio and creatinine values at admission. Patients were classified into different prognostic groups according to their 28-day mortalities and simplified MELD score. Kaplan-Meier survival curve was used to analyze the 1-year accumulate survival rate,and ROC curve was used to evaluate the performance of different scoring systems in predicting 28-day mortality. Results:Simplified MELD score at admission could classify HBV-related cirrhotic patients with AD into low,moderate and high 28-day mortality groups and different long-term prognostic groups;the score of low,moderate and high 28-day mortality group was 0-2,3 and 4-6,respectively,and the corresponding mortality was 5. 5% ,19. 8% and 48. 6% ,respectively. Simplified MELD score had the same good performance as compared with the CLIF-C OF,MELD and MELD-Na scores in predicting 28-day mortality,the area under ROC curve was 0. 828,0. 831,0. 828 and 0. 830,respectively. Conclusions:Simplified MELD score can accurately classify HBV-related cirrhotic patients with AD into low,moderate and high 28-day mortality groups at admission. It is convenient for using in clinical practice.

Objective To study the expression of interleukin-17 (IL-17) in diabetic rat aorta and the effect of intervention with resveratrol,meanwhile,to explore the potential mechanisms of IL-17 induced diabetic vascular diseases and the protective role played by resveratrol in the epigenetic field.Methods The experiment was carried out in 4 groups:normal control group(NC),normal interventional group(NB),diabetic group(DM),and diabetic interventional group(DB),NB and DB groups were intervened with resveratrol.Immunohistochemistry was used to observe the histological localization of IL-17 and to measure the thickness of rat abdominal aorta.Western blotting,real-time PCR,and methylation-specific PCR were used respectively to compare the expression of IL-17 protein and mRNA,as well as DNA methylation in 4 groups.Results IL-17 mainly expressed in arterial intima of diabetic rats,the abdominal aorta in DM group was obviously thicker than that in NC and DB groups(P＜0.05).IL-17 protein and mRNA expressions in DM group were significantly higher than NC group(P＜0.05),and were reduced in NB and DB groups compared with NC and DM groups respectively.While DNA methylation levels of IL-17 in DM group were significantly lower than NC group(P＜0.01),however,the levels in NB and DB groups were elevated accordingly as compared with corresponding groups.Conclusions The increased levels of IL-17 in aorta of diabetic rats suggests that IL-17 is involved in the process of inflammatory responses to diabetic macrovascular diseases,while resveratrol could inhibit the expression,it may play a role in protecting aorta,and the regulation of IL-17 gene promoter DNA methylation levels may be the potential mechanism underlying these two phenomena.

The concept of epigenetics was first proposed by Waddington in 1942,referring to phenotypic changes that are not related to the underlying DNA sequence,yet alterations in the level and function of gene expression can be heritable,such as DNA methylation,histone modifications,microRNA interference,etc.Phenotype changes while genotype remains unchanged,this controlled mechanism can be kept stable throughout cell division,proliferation,and subsequent process of development.This process thus may cause corresponding changes in the pathophysiology,which are correlated with the occurrence of cancer,immune disorder,cardiovascular disease,metabolic syndrome and so on.Diabetes mellitus is the third heaviest chronic diseases in the world,and does serious harm to human health,especially the diabetic vascular diseases.Even if the blood glucose level is controlled in an ideal state,vascular inflammation still persists,indicating the existence of metabolic memory.Studies have suggested that the pathogenesis can be elucidated at the level of epigenetics.This paper mainly focuses on DNA methylation,histone modifications,and is an overview of epigenetics research progress in diabetic vascular diseases.

Secretory diarrhea provides a major health challenge worldwide, which is one of the most important reasons for children morbidity and death. The activation of Cl- channels in intestinal epithelial cells resulting in the excessive fluid secretion in the intestine is the main reason of diarrhea caused by enterotoxins. In diarrhea caused by cholera and the other bacterial enterotoxins, cystic fibrosis transmembrane conductance regulator ( CFTR) is the main cAMP-control Cl- channel to promote the fluid secretion in epithelial cells. Therefore, CFTR inhibitors are the new choices for secretory diarrhea. CFTR inhibitors include thiazolidinone, glycine hydrazide and quinoxalinedione chemical classes, and some components from natural plants also exhibit CFTR inhibition activity, however, further studies should be done.

Several specialized branches are inclusive in the department of trauma surgery,and the instruction of medical ethics during the practice of trauma surgery surely contributes to raise the integrated diathesis and capability for medical students.Common ethical issues in trauma surgery practice include ethics of operative principles,conflict between trauma sufferers and accident-makers,privacy preservation,decision making,and the principles of clinical pharmaceutical trials,etc.It is believed that advantageous principles and independence principles should be overall carried out during the instructional course of medical ethics education.

BACKGROUND:Estrogen signaling pathway for interaction between aromatase and estrogen-related receptor may exist in bone marrow mesenchymal stem cel s, which is used for regulating biological activity of bone marrow mesenchymal stem cel s. OBJECTIVE:To observe the expression of aromatase and estrogen-related receptors in adult bone marrow mesenchymal stem cel s during osteogenic differentiation. METHODS:Bone marrow mesenchymal stem cel s were respectively cultured in low-glucose DMEM medium (control group) and osteogenic induction medium (induction group). Cel proliferation and calcium deposition were determined by MTT assay and alizarin red staining, respectively. The expression of aromatase, estrogen receptorα, estrogen receptorβ, and estrogen-related receptorαduring osteogenic differentiation were determined by real-time PCR and western blot analysis. Estradiol levels in supernatants and lysates were detected by ELISA method. RESULTS AND CONCLUSION:In the induction group, the proliferation ability of bone marrow mesenchymal stem cel s was the strongest at 72 hours of culture;while there were a great amount of calcium nodules formed at 21 days of culture. Results from PCR and western blot assay showed that the expression of aromatase and estrogen receptorαwas improved in the induction group, but the expression of estrogen-related receptorαwas inhibited. There was no difference in the expression of estrogen receptorβbetween the two groups. ELISA results indicated that the level of estradiol in the supernatant of induction group was the highest. These findings indicate that aromatase, estrogen receptorα, estrogen receptorβand estrogen-related receptorαare al involved in osteogenesis of bone marrow mesenchymal stem cel s. Moreover, estradiol can be synthesized and secreted in bone marrow mesenchymal stem cel s, and most likely, promote the osteogenic differentiation of bone marrow mesenchymal stem cel s by related receptor pathway.

Rectal diverticulum is rarely seen in clinical practice.Perforation or rupture of rectal diverticulum with symptoms and signs of acute diffuse peritonitis makes it easily be misdiagnosed as appendicitis,rectal neoplasms,intestinal obstruction and other abdominal diseases.In this article,a retrospective analysis of the clinical data of one patient with extraperitoneal pneumatosis caused by perforation of rectal diverticulum was performed to investigate the diagnosis and treatment of the disease.