It has been realized that the 4Rs (repair,repopulation,redistribution,and reoxygenation) would affect the result of cell irradiation,and thus radiation treatment.The 4Rs each occurs at different dose rates,usually very low dose rates.Depending on the dose rate used for treatment,the corresponding R should be included in the linear-quadratic equation (LQ) and biological effective dose (BED) calculation.For low dose rate brachytherapy(LDR) especially permanent implant,all the 4Rs should be included in LQ for BED calculation.The 4Rs,especially repair and repopulation,play a critical role in dose fractionation.Various dose fractionation schemes such as hyperfractionation and hypofractionation are determined in consideration of the 4Rs.Stereotactic radiation therapy uses hypofractionation with high fractional doses and combine with high accuracy target localization techniques to achieve high local control rates compared to conventional dose fractionation schemes.The 4Rs have been taken into account for LDR and permanent implant.Recently,LQ for permanent implant brachytherapy has been modified to include all the 4Rs for gynecological malignancy 131Cs permanent implants.Including the 4Rs in radiation therapy has significantly improved the effectiveness and efficiency of radiation therapy for cancer treatment.

High intensity focused ultrasound (HIFU)is a new technology of focal therapy for patients with hepatic carcinoma.Comparing with operation and other focal therapeutic methods (such as radiofrequency and transcatheter arterial chemoembolization) of liver cancer,HIFU is non-invasive,accurate,and definite in killing the tumor tissue with fewer complications.Thus,it is widely accepted in clinical settings and has a promising prospect.In this article,we review the mechanism and present situation of hepatic carcinoma therapy with HIFU and dicuss some clinical application and development in the future.

Objective To explore the effective prognostic factors of patients with multiple traumas. Method During January 2003 to March 2007, totally 324 patients with multiple traumas were treated in the emergency department of Renmin Hospital, Wuhan University. The relationship between prognosis and age, visiting time after injury, injury severity score (ISS) ,main wounded part and shock degree was analyzed. The data were tested using ehi-square test and logistic regression method. Results Seventy-eight patients died and 246 patients survived, the total mortality was 24.1%. Statistical differences existed in mortalities of patients with different visiting time (visiting hospital within 1 h,16.7%; visiting hospital beyond 1h, 37.4%),ISS (16≤ISS≤24, 5.7%; 25≤ISS≤40, 19.2%; IS8>40, 41.3%) and shock degree (non-shock, 11.8%; mild shock, 13.6%; moderate shock,27.7%; severe shock,46.9% ) ( P<0.01). There were no significant difference in mortalities among patients with different age (<18, 23.8% ; 18～38, 21.7% ; 38～58, 24.2% ;>58, 32.5% ) and with various main wounded part (head, 26.0%; neck, 25.3%; chest, 27.3%; abdomen, 24.1%; limbs, spine and pelvis,16.3%), P>0.05. Logistic regression study showed that mortality increased with postponed visiting time after injury, augment of ISS and aggravation of shock degree, with the exception that there was no differenoe in mortality of patients with between non-shock and mild shock. Conclusions Visiting time after injury, ISS and shock degree were valuable progrostic predictors for multiple traumas. It's vital to follow principle of damage controlled surgery and emphasis on the timeliness and integrity of medical rescue and control shock actively to reduce mortality of patients with multiple injuries.

Objective To investigate IL-1?mRNA expression and protein secretion after ultraviolet irradiation in human keratinocyte(KC)originated SCC12F cells.Methods Expression of IL-1?mRNA was detected by Northern blot and the secretion level of IL-1?protein was analyzed by ELISA.Results There was a spontaneous expression of IL-1?mRNA in SCC12F cells in culture system of normal KC,which was increased along with the culture time,and reached the highest expression level in120hours.The secretion level of IL-1?protein was increased in a time-and dose-dependent manner in SCC12F cells after ultraviolet B(UVB)irradiation.Conclusions SCC12F cells may express IL-1?mRNA spontaneously under regular KC media.The secretion level of IL-1?protein shows both time-and dose-effect after UVB irradiation.

Objective To evaluate clinical value of tumor biomarkers in ascitic fluid and serum in differentiating benign from malignant ascites and their correlation. Methods From July 2006 to July 2009,67 patients with ascites undergone abdominal paracentesis in Renmin Hospital of Wuhan University were enrolled in the study and divided into malignant and benign groups according to their etiology. Levels of tumor biomarkers in ascitic fluid and serum were determined and their correlation were analyzed. Diagnostic sensitivity and specificity of tumor markers were evaluated. Results There was statistically significant difference in levels of cancer antigen 199 (CA199) in serum and ascitic fluid between the malignant group and the benign one ( P ＜ 0. 01 ), and level of cancer embryonic antigen (CEA) significantly increased in ascitic fluid (P ＜ 0.05 ). Levels of CA199 and CEA in serum were significantly higher than those in ascetic fluid in the benign group (P ＜ 0. 01 and P ＜ 0. 05 ), and level of CA125 was significantly lower in serum than that in ascitic fluid (P ＜ 0. 01 ). Level of alpha-fetal protein (AFP) in serum significantly correlated with that in ascitic fluid in the benign group (r =-0. 992, P ＜0. 01 ). In the malignant group, levels of CA199, CEA and CA125 were significantly higher in ascitic fluid than those in serum (P ＜0.05 or P ＜0. 01 ). Levels of CA199 and CEA in serum significantly correlated with those in ascetic fluid in the malignant group (r =0. 746 and 0. 572, respectively, P ＜0. 01 ), and level of AFP in serum also correlated with that in ascetic fluid (r=0. 384, P ＜0. 05). Ratios of levels of CA199 and CEA in ascetic fluid to those in serum (F/S) were significantly higher in the malignant group than those in the benign group (P ＜0.05 or P ＜0.01). Use of combination of CA199, CEA and CA125 determinations showed a higher sensitivity and specificity in differential diagnosis for benign and malignant ascites (P ＜0.05). Conclusions Determinations of CA199 and CEA are beneficial for differentiating benign ascites from malignant one. Determinations of tumor biomarkers in serum can not fully replace those in ascetic fluid. Combined determinations of CA199, CEA and CA125 can increase their sensitivity and specificity in diagnosis for malignant ascites.

Objective To study the clinical features of large-artery atherosclerosis cerebral infarction and perforating artery disease type cerebral infarction.Methods Ninety cases of large-artery atherosclerosis cerebral infarction were set as the observation group and 90 cases of perforating artery disease type cerebral infarction as the control group.The general data and clinical characteristics were performed the comparative analysis.Results The drinking and smoking rates in the observation group were 43.33 ％ and 54.44 ％ respectively,which were in turn higher than 27.78 ％ and 25.56 ％in the control group;the occurrence rates of complicating coronary heart disease and lipid metabolism abnormality in the observation group were 45.56 ％and 58.89 ％respectively,which were in turn higher than 21.11 ％ and 37.78 ％in the control group;while the occurrence rate of complicating diabetes mellitus in the control group was 65.56 ％,which was higher than 42.22％ in the observation group,the differences were statistically significant(P＜0.05).Plasma oxidized low density lipoprotein and circulating endothelial cell count in the observation group were (687 ± 169)g/L and(9.0 ±1.7) × 106/L respectively,which were significantly higher than the normal level in the control group,the level of nitric oxide in the observation group was(77.4±21.1)mol/L,which was lower than that in the control group.The differences between the two groups were statistically significant(P＜0.05).Conclusion The onset factors of large artery atherosclerosis cerebral infarction have larger relation with drinking,smoking,complicating coronary heart disease and lipid metabolism abnormality,while perforating artery disease type cerebral infarction is more related with diabetes.

Bone marrow mesenchyma stem cells are stem cells that occupy self-renewal and multiple differentiations into cells,which have been recognized as the optimal origin for liver cell.With an increasing number of studies addressing marrow mesenchyma stem cells,more attention has been drawn to treating liver disease using the stem cell and organ reconstruction,especially seeks for the appropriate in vitro induction system.This paper comprehensive summarized the differentiation characteristics of marrow mesenchyma stem cell under many kinds of micro environment,and explains the superiority,as well as existence question of each kind of induction condition.

Objective: To discuss the essential aspects of per operation period nursing intervention in tooth extraction under electrocardiogram monitoring for the elderly patients, so as to improve the success rate of surgery. Methods:According to the physiology and psychology characteristics of the elderly patients, psychological intervention and correct cooperation were provided by nurse along with the electrocardiogram monitoring during the whole process. Results:Seven hundred and nineteen cases of elderly patients went through a smooth operation of tooth extraction under electrocardiogram monitoring. Conclusion: It is highly important that we combine professional medical team with tacit cooperation, appropriate psychological intervention as well as good management system to succeed in tooth extraction under electrocardiogram monitoring.

Objective:To propose the requirement of hospital development quality inspection information management system, develop solution, avoid cost enormous waste problem and realize the system on-line.Methods: Use the UML method to develop hospital equipment management information system, and completed a detailed description of its specific use case diagram, sequence diagram, class diagram.Results: Equipment operation rate increased by 10%, significantly shorten specimens control time of, the fault response time decreased from 10min to 1 min, quality control indexes increased to 16%.Conclusion: The UML-based LIS system improved the work efficiency of the equipment, received the satisfactory effect.

Objective To manufacture the skin suction blister apparatus and observe the curative effect of autologous epidermal grafting in treating vitiligo.Methods According to the theory of local skin suction blister: local skin suction blister is decided by the two facts of the negative pressure and temperature,the skin suction blister apparatus was manufactured based on feedback principle,and was applied to autologous epidermal grafting for treating vitiligo.Results The performance of skin suction blister apparatus was stable,the operation was relative simple,and the total survival grade of autologous epidermal grafting was 98.01%.Conclusion The skin suction blister apparatus is simple to operate and its curative effect is excellent for clinical application.