Objective To investigate the difference of impulsiveness between patients of obsessivecompulsive disorder(OCD) and healthy controls.Methods Seventy-one patients who met the DSM-Ⅳ criteria for OCD,and sixty-five healthy controls were recruited.Impulsiveness and the severity of symptom were assessed with Barratt Impulsivity Scale (BIS-11) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before and the end of 16th week treatment.Results Before treatment,attentional impulsivity scores(14(12,16)) and non-planning impulsivity scores (26 (23,28)) were significandy higher (all P＜ 0.01) in OCD patients compared with controls (12 (11,13),23 (20.5,26)).Mter treament,the reduction rate of attentional impulsivity was positively correlated with the reduction rate of Y-BOCS (r=0.443,P=0.018).Logistic regression analysis reported that with the total scores of BIS-11 increased,the effect of treatment was improved (β=-0.149,P=0.002).Conclusion Increased attentional and non-planning impulsivity are found in OCD.As the improvement of symptom,the scores of attentional impulsivity are also decreased.The high total scores of BIS-11 are correlated with the efficacy of treatment.

Background and purpose: With the development of therapy equipments and technology, the treatment for nasopharyngeal carcinoma(NPC) has entered into the era of precision radiotherapy, and setup errors have become a very important factor affecting treatment effects. The purpose of this study was to analyze the set-up errors detected by the kilovoltage cone beam CT(EPID) and the megavoltage electronic portal imaging device(CBCT) using 2 kinds of different immobilization techniques (pillow+head neck shoulder mask and vacuum bag+head neck shoulder mask) for NPC patients. Methods:A total number of 40 NPC patients were randomly assigned into 2 groups (pillow+head neck shoulder mask group and vacuum bag+neck shoulder mask group). Then each group was further divided into CBCT scan group and EPID group for veriifcation before treatment delivery. We matched the EPID images with the DRRs and acquired the set-up errors in x, y, z axis. Setup errors of CBCT were calculated according to its matched and planned CT images in left-right (x), superior-inferior (y) and anterior-posterior (z) directions. Paired t-test was used to evaluate the differences. Results:In the pillow+head neck shoulder mask group, the set-up errors of CBCT in the x, y, z axis were x (0.67±2.01)mm, y (0.51±1.71)mm and z (0.57±2.04)mm, respectively. The errors of EPID were x (0.69±2.19)mm, y (0.54±2.03)mm and z (0.61±2.11)mm. In the vacuum bag+head neck shoulder mask group, the set-up errors of CBCT in the x, y, z axis were x (0.42±1.81)mm, y (0.33±1.55)mm and z (0.50±1.75)mm, respectively. The errors of EPID were x (0.44±1.87)mm, y (0.43±1.70)mm and z (0.54±1.77)mm. The vacuum bag+head neck shoulder mask ifxed technique was more accurate when compared to the pillow + head neck shoulder mask ifxation method (P<0.05). Conclusion:CBCT and EPID were similar in detecting set-up errors for the NPC patients. However, the vacuum bag+neck shoulder mask ifxed technique was more accurate when compared to the pillow+head neck shoulder mask ifxation method.

Objective To analyze relevant factors of cervical intraepithelial neoplasia residual or recurrence after loop electri‐cal excision procedure(LEEP) .Methods We observed the patients who were histopathologically confirmed CIN and treated with LEEP in our hospital from January 2006 to September 2012 ,and investigated the postoperative residual and recurrence .Then we an‐alysed relevant factors of residual or recurrence .Results (1)After at least 2 years of follow‐up ,26 cases showed residual or recur‐rence(the residual rate was 0 .97% and the recurrence rate was 4 .08% ) .(2)Overall severity of residual or recurrence had been re‐duced ,but the severity and recurrence of preoperative severity was positively correlated(r=0 .354 0 ,P<0 .05) .(3)Age ,smoking , preoperative high‐risk HPV load ,post‐operative the same type of HPV continuous infection ,endocervical involvement ,lesions in‐vo1ving quadrants ,and post‐operative TCT results between the recurrence group and non‐recurrence group were statistically signifi‐cant different(P<0 .05) .Conclusion CIN residual or recurrence after LEEP might be affected by many factors ,and the treatment should be individualized .

Objective To study the influence of different positions in the isokinetic muscle test of knees by CON-TREX Biomechanical Test and Training System, so as to select the suitable conditions for forensic identification of muscle strength test. Methods Fifty-two healthy volunteers joined the isokinetic muscle strength test in unfixed and fixed position, respectively and in two kinds of angular speed (60°/s and 30°/s). The differences of peak torque (PT) and peak torque angle (PTA) between bilateral knee flexor and extensor were statistically analyzed. Results In the unfixed position, under the two speed, there was statistically significant difference in PT between bilateral knee flexor and extensor (P<0.05);while in the fixed position, under the two speed, there was no statistically significant difference (P>0.05). In any kind of conditions, the PTA of bilateral knee flexor and extensor did not have statistically signifi-cant difference(P>0.05). Conclusion The position of the subject influences the results of PT. So the po-sition of subject in knees isokinetic muscle test should be regulated.

Objective To study the application of isokinetic muscle testing in identification of the faked paralysis to provide scientific data for establishing a standard systemof muscle strength in forensic medicine identification. Methods Fifty-seven patients with bone fracture or nerve damage as damaged group and 128 normal subjects pretended paralysis as faked paralyzed group were included in this study. Isokinetic muscle testing was performed on bilateral knees of all subjects in the two groups. The peak torque (PT) and peak torque angle (PTA ) were compared between both sides in each group. The fea-tures of torque-time graph of two groups were classified. Results In the damaged group, the differences of PTbetween two sides of flexors and extensors were statistically significant (P<0.05), while the dif-ferences of PTA were not statistically significant (P>0.05). In faked paralyzed group, the differences of PTand PTA between two sides of flexors and extensors were both statistically significant (P<0.05). The torque-time graph of damaged knee presented mostly as single lead peak, while torque-time graph of the faked paralyzed knee presented mostly as multiple peaks. Conclusion The feature of torque-time graph could be useful to identify the faked paralyzed extremities in forensic authentication.

Objective To analyze reasons for unplanned return-to-theater obstetrical surgery in patients with placenta previa, and to propose a strategy for prevention.Methods Among 571 patients with placenta previa in the Department of Obstetrics, First Affiliated Hospital of Nanjing Medical University from January 2010 to January 2015, ten cases (1.75％) who had an unplanned return-to-theater obstetrical surgery were retrospectively analyzed.Results Seven out of the ten cases returned to the theater due to severe hemorrhage after cesarean section and hysterectomy or uterine artery embolization was performed.The rest three pregnancies were terminated at mid-term with amniotic injection of rivanol, two of which developed severe infection after the induction combined with uterine artery embolization followed by cesarean section,and the other one finally had an emergent hysterectomy due to severe postpartum hemorrhage after cesarean section because of intrapartum hemorrhage.Severe postpartum hemorrhage occurred in eight out of the ten cases, with a mean volume of (4 212± 1 651) ml.Blood loss between the original and return-to-theater surgery was (2 206± 736) ml.In these eight cases, the mean volume of erythrocyte suspension transfusion was (23.7±9.0) U, and [M(min-max)] 1 845(390 3 960) ml for plasma transfusion.Platelet transfusion was performed in five cases, cryoprecipitate transfusion in eight cases, serum albumin transfusion in six cases, and fibrinogen transfusion in five cases.The interval between original and return-to-theater surgery was 2.0(0.5-19.0) h.After the return-to theater surgery, the time of antibiotic use was (9.2±2.3) d, and the duration of hospital stays was (10.6±2.5) d.No patient required further re-operation, and all were discharged without long-term sequelae.All seven neonates had a good prognosis.Conclusions Severe postpartum hemorrhage in patients after initial operation because of placenta previa is the primary indication for unplanned return-totheater surgery.Closed postoperative monitoring, early recognition and expedite return-to-theater surgery are crucial to stop bleeding and save lifes.

Objective To investigate the diagnostic value of texture analysis derived from conventional MR imaging in differentiating benign and malignant breast lesions. Methods Thirty-six patients with malignant breast lesion and 33 patients with benign breast lesion were retrospectively analyzed in our study. All patients underwent conventional MR imaging including axial T1WI, T2WI, and contrast-enhanced T1WI before surgery. Texture features were calculated from manually drawn ROIs by using MaZda software. The feature selection methods included mutual information (MI), Fishers coefficient, classification error probability combined with average correlation coefficients (POE + ACC) and the combination of the above three methods(FPM). These methods were used to identify the most significant texture features in discriminating benign breast lesion from malignant breast lesion. The statistical methods including raw data analysis (RDA), principal component analysis (PCA), linear discriminant analysis (LDA) and nonlinear discriminant analysis (NDA) were used to distinguish malignant breast lesion from benign breast lesion. The results were shown by misclassification rate. Results In the three kinds of sequences, the texture features for differentiating malignant breast lesion and benign breast lesion were mainly from T2WI which had the lowest misclassification rate 4.35%(3/69). The misclassification rates of the feature selection methods were similar in MI, Fisher coefficient and POE+ACC (15.94%to 56.52%for MI;17.39%to 56.52%for Fisher coefficient and 17.39%to 56.52%for POE+ACC). However, the misclassification rate of the combination of the three methods (4.35%to 53.62%for FPM) was lower than that of any other kind of method. In the statistical methods, NDA (4.35% to 27.54%) had lower misclassification rate than RDA (33.33% to 56.52%), PCA (33.33% to 53.62%) and LDA (15.94% to 44.93%). Conclusion Texture analysis of conventional MR imaging can provide reliably objective basis for differentiating benign from malignant breast lesions.

Objective To investigate the dynamic abnormality of anorectum in elderly patients with chronic constipation.Methods Anorectal perfusion manometry was performed to detect the change of anal canal pressure and the rectal sensation capacity in 58 elderly patients and 36 non-elderly adults with chronic constipation.The results were compared retrospectively.Results Anal resting pressure in a chronic constipation was significantly lower in elderly patients than in non-elderly adults,with statistically significant difference [(59.74 ± 2.31) mmHg vs.(68.22 ± 2.37) mmHg,t =2.430,P =0.017].The incidence of paradoxical motility of anal sphincter was significantly higher in elderly patients with three abnormalities(incomplete defecation,Bristol stool scale type 3-5 and straining at defecation) than in elderly patients without above three abnormalities (x2 =8.880、11.540、6.070,P =0.003、0.001、0.014).Maximal tolerable volume was significant lower in elderly patients with straining at defecation and abdominal pain than in control group (t =2.140,2.260,both P ＜ 0.05).No correlation was observed between sex and anorectal motility in elderly patients with chronic constipation.Conclusions Anorectal motility in elderly patients with chronic constipation is different from that in non-elderly patients with chronic constipation.The dynamic abnormalities of anorectum in chronic constipation are different in elderly patients with different symptoms.

Objective To analyze the incidence and related factors of acute radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) who underwent three-dimensional conformal ra-diotherapy with concurrent chemotherapy. Methods From January 2006 to October 2008, 90 NSCLC pa-tients treated with concurrent chemoradiotherapy were retrospectively reviewed. The clinical characteristics and treatment plan parameters from dose-volume histogram (DVH) were analyzed. Results Grade 1, 2,3, 4 and 5 RP was found in 32.2%, 30.0%, 5.6%, 0% and 1.1% of the patients. Primary tumor loca-tion was the only significant clinical factor in univariate analysis. And significant differences were found when the groups was divided by the mean lung dose (MLD) of 17 Gy, V_(5) of 47% ,V_(10) of 36% ,V_(20) of 24%,V_(30) of 23% and V_(40) of 22%, respectively. Multivariate analysis showed the MLD was the only independent predictive factor of RP. Conclusions Some factors may contribute to the RP. MLD should be set below 17 Gy in three-dimensional conformal radiation, especially when the tumor locates in the lower lobe.

Background and purpose: Phosphatase and tensin homologue deleted on chromosome 10 (PTEN) gene is a kind of tumor suppressors, which has been reported to be underexpressed in endometrial carcinoma (EC) tissues by several reports. However, the biological effects and possible mechanisms of PTEN on EC have been known less. In this study, we tried to investigate the effects and possible mechanisms of PTEN on the invasion and migration of endometrial carcinoma cells and to provide a potential target for endometrial carcinoma therapy. Methods:The recombinant plasmid pIRES2-ZsGreen1-PTEN was rebuilt by gene recombination technology;The plasmid was transferred into HEC-1B cells and the cells transfected with pIRES2-ZsGreen1 plasmid were used as control;The expression of PTEN was observed by fluorescence microscope and Western blot assay;Cell migration and invasion was determined by the wound healing assay, transwell migration and invasion assays respectively;The Western blot analysis was performed to detect the expression of ATP-dependent tyrosine kinase (AKT), phosphorylated-AKT (p-AKT) and matrix metalloproteinase-2 (MMP-2). Results:The agarose gel electrophoresis showed a stripe of 1.2 kb which was same to PTEN cDNA;The sequence analysis showed the PCR products owned the same sequence with the coding region of PTEN cDNA in GenBank, suggesting the recombinant plasmid was constructed successfully;The green light of cells observed by fluorescence microscope and the Western blot analysis showed the expression of PTEN was upregulated in the cells transfected with the recombinant plasmid, suggesting the plasmid expressed successfully in HEC-1B cells;The wound healing assay as well as transwell migration assay showed ectopic expression of PTEN suppressed cell migration;The invasive capacity of HEC-1B cells was significantly decreased upon transfection with PTEN plasmid compared to control and untreated groups;Moreover, compared with the control groups, the expression of p-AKT and MMP-2 was downregulated, while there was no significant alteration of the expression of AKT. Conclusion:PTEN could suppress cell migratory and invasive ability of endometrial carcinoma cells by suppressing the phosphorylation of AKT followed by the decrease of MMP-2.