Objective:To discuss the pathogenic factors,prevention and treatment of fulminant epidemic of acute tonsillitis and acute pharyngitis.Method:We investigated and analysed the cases of twice fulminant epidemic of acute tonsillitis and acute pharyngitis.Result:In the first time,91 patients among 518 persons were attacted,the sick rate was 17.6%.In the second time,39 among 295 persons were attacted,the sick rate was 13.2%.The main symptoms were pharyngodynia and fever.Bacterial culture of throat swab of 20 cases of the first time and 17 cases of the second time were carried out.The positive rate of β-hemolytic streptococcus was 82.5% and 85.3% respectively.Conclusion:Environment and individual health condition are important factors in the fulminant epidemic of acute tonsillitis and acute pharyngitis.

Objective To develop a practical image acquisition strategy using intermittent breath?hold cone beam computed tomography (CBCT). Methods A breathing phantom was used to simulate the movement of tumor near the diaphragm during free breathing and breath hold and scanned by conventional breath?hold CBCT and type Ⅰ/Ⅱ intermittent breath?hold CBCT. In the conventional breath?hold CBCT, scan paused and free breathing occurred at the break of breath hold and free breathing was not included in the scan. In the intermittent breath?hold CBCT, one scan covered several breath holds separated by free breathing in a ratio of 3 vs1. Image quality and three?dimensional registration accuracy were quantitatively compared between conventional breath?hold CBCT and type Ⅰ/Ⅱ intermittent breath?hold CBCT. Comparison of image quality parameters between conventional breath?hold CBCT and intermittent breath?hold CBCT was made by paired t test. Results Motion artifacts arose in type I and Ⅱ intermittent breath?hold CBCT scans. There were no significant differences in the reconstructed pixel value or uniformity between intermittent breath?hold CBCT and conventional breath?hold CBCT ( P>0. 05, and P= 0. 02, 0. 53 ) . Compared with conventional breath?hold CBCT images, the signal?to?noise ratios of type I andⅡintermittent breath?hold CBCT images were reduced by 30% and 60%, respectively ( P<0. 05 ) . The registration error was up to 0 . 4 cm in the anterior?posterior direction and less than 0 . 1 cm in other directions . Conclusions The phantom study shows that intermittent breath?hold CBCT does not significantly reduce image quality or registration accuracy compared with conventional breath?hold CBCT. The feasibility of intermittent breath?hold CBCT in clinical application needs to be further validated among a large number of patients.

To meet the requirements for the development of marine resources and military operations, divers usually dive deeper than the depth at which narcosis is present during air diving.Under this condition, heliox is required for this div-ing.Sofar, some countries have developed their own decompression tables for routine heliox diving.The best-known is tables from USA and France.In the preceding century, tables of Former Soviet Union and France used for routine heliox diving were introduced into China.On the basis of both types of tables,Chinese Navy developed their own tables for this purpose. In this paper, we summarized the characteristics of these tables from 5 countries and compared them in terms of structure, oxygen use, total decompression time, first stop and other features.This may provide a basis for future modification of ta-bles used in China and the development of new tables for routine heliox diving.

Objective To investigate the efficacy and safety of 3D-laparoscopic surgery in adrenalpheochromocytomas /paragangliomas.Methods From December 2012 to July 2014,23 cases of adrenal pheochromocytomas/paragangliomas were treated by 3D-laparoscopic surgery.Among them,7 cases were male and 16 cases were female,whose mean age are 47 (32-68) years old.Their clinical symptoms including sustained hypertension in 11 cases,intermittent hypertension in 8 cases,sustained hypertension with intermittent progression in 2 cases and asymptom in 2 cases.All tumors were diagnosed by endocrine examination,image test and nuclear medicine.Mean diameter of tumors are 8 cm,ranged from 3-14cm.In order to adjust the blood pressure,patients took α-receptor blocker for 2-4 weeks preoperatively.Under the general anesthesia,19 patients received the 3D-laparoscopic surgery via retroperitoneal approach and 4 cases received the procedure via peritoneal approach.Results All operations were completed successfully.There were no major intraoperative complications.Mean operating time was (78 ± 21) min and mean estimated blood loss was (54.8 ± 36.3) ml.Mean hospital stay after operation was (3.8 ± 1.4) days.The pathological diagnosis included pheochromocytomas in 15 cases and paragangliomas in 8 cases.During the 3 to 18 months following up,no recurrence or metastasis was found in this study.Conclusions 3D-laparoscopic surgery has obvious advantage in spatial location and the sense of depth for adrenal pheochromocytomas /paragangliomas,which shortens the operation time and increase the safety obviously.

Objective To compare the dose distribution of the target and normal tissues in gastric cancers between three-dimension conformal radiation therapy (3DCRT) and intensity modulated radiation therapy (IMRT) plan when respiratory motion factors integrated in the plan. Methods From January 2005to November 2006, 10 patients with post-operatively radiation of gastric cancer were enrolled in this study.Planning CT were acquired conventionally with free-breath mode and the static treatment plans of the 3DCRT and IMRT were designed respectively. Probability distribution functions (PDF) were generated and convoluted with the static dose distributions from 3DCRT and IMRT plans to obtain the integrated plans. The dose distributions of the target and normal tissues were compared between 3DCRT and IMRT integration treatment plans, such as V45 of clinical target volume, V4o of liver and V15, V18 of left and right kidney.Results In the respiratory integrated treatment planning, the target volume coverage and homogeneity with IMRT are superior to those with 3DCRT ( ( V45 98%∶ 87% (t = -3. 35 ,P =0. 010) ,mean dose 46. 81 Gy ±0. 75 Gy∶45.99 Gy ± 1.12 Gy (t = -0. 31 ,P=0. 020) ). The V40 of teh liver in IMRT are smaller than those in 3DCRT ( 12%∶ 16% ;t=3.75,P=0.010). For the left kidney, the V15 and V18 in IMRT are smaller than those in 3DCRT ( (34%∶ 50% (t = 2. 17 ,P = 0. 050) and 27%∶46% (t = 3. 11 ,P = 0. 020) ),but for the right kidney, V15 and V18 in 3DCRT are smaller than those in IMRT ( ( 15%∶ 21% (t = - 2. 42,P=0.040) and 11%∶15% (t= -2.71,P=0.030)). Conclusions When respiratory motion factor integrated in the treatment plan, IMRT showed advantage both in target coverage and normal tissue sparing in the high dose region of liver and left kidney.

Objective To assess the long-term outcome of unilateral adrenaletomy in patients with adrenocorticotropic hormone independent macronodular adrenal hyperplasia (AIMAH).Methods The data from 82 cases of AIMAH were reviewed and summarized including clinical manifestations, endocrinological data, imaging findings and postoperative follow-up.Fouty-nine males and thirty-three females with a mean age of fifty years composed our series.Among the 82 cases, 41 demonstrated Cushing syndrome (CS), 74 presented with hypertension, 38 manifested diabetes mellitus, 35 complicated of osteoporosis and 11 of them with bone fracture, 39 complained of edema.Laboratory tests showed low ACTH plasma levels (＜ 2.2 pmol/L) in 62 of 79 cases.High level of 24-hour urinay free cortisol excretion(＞ 284.2nmol/L) was found in 67 of 79 cases.Elevated serum cortisol with loss of the circadian rhythm was presented in 55 of 60 cases.Failed to suppress cortisol secretion was observed in 61 of 63 conducted with low-dose dexamethasone suppression tests and in 47 of 53 implemented with high-dose dexamethasone suppression tests.Bilateral massively enlarged multinodular adrenal glands were found in all cases with CT or MR imaging.Unilateral adrenalectomy was performed in the larger side of adrenal gland in all 82 cases.All adrenalectomies were carried out including 47 in right sides and 35 in left sides, with 77 by retroperitoneoscopic approach and 5 by open retroperitoneal approach.Results Histopathological examination confirmed nodular hyperplasia of the adrenal cortex for all specimens.After a mean duration of 48.5 months, 80 of 82 patients were available for follow-up.Most clinical symptoms resolved within 6 months after operation.Cushingoid features disappeared in 58.5％ (24/41)of patients who initially presented with typical signs of Cushing Syndrome.Weight loss was seen in 56.3％ (45/80).Improvement of hypertension and diabetes was observed in 63.5％ (47/74) and 76.3％ (29/38) respectively.All the eyelids swelling and edema of the limbs subsided within 3 months.In long-term follow-up (more than 6 months), 82.9％ (63/76) had clinical and biochemical recurrence within a mean time of 14.6 months and 46.0％ (29/63) received contralateral adrenal surgery.Two patients died, one died from heart attack and another one died from pulmonary infection, 2 years and 7 years after unilateral adrenalectomy, respectively.Conclusions Unilateral adrenalectomy just has transient efficiency for AIMAH.Most patients will experience clinical and biochemical recurrence for a long period,and have to receive another operation for the contralateral hyperplastic adrenal gland.

Insertional mutagenesis is a widely used method to determine the function(s) of a gene. To study the function(s) of the gene nsdAmgh in Streptomyces roseoflavus, a homologous recombination vector pSRNA2500 was structured in this paper. The recombination donor vector was then transformed into Strempomyces roseoflavus strain Men-myco-93-63 by conjugative transfer. The transformants were subjected to selection under the pressure of high temperature and appropriate antibiotics. As a result, several disrupted mutants of nsdAmgh gene, with a phenotype of Am(s)Km(r), were isolated and verified using PCR and Dot-blotting and Southern blotting hybridization methods. Functional analysis showed that the disrupted mutants of nsdAmgh had a two-fold higher inhibition against Verticillium dahlia Kleb than that of the wild strain Men-myco-93-63, which all will provide a new study route for future research about positive and negative regulator in Men-myco-93-63.
Genes, Bacterial ; Genetic Vectors ; Mutagenesis, Insertional ; Polymerase Chain Reaction ; Streptomyces ; genetics

Objective To assess the impact of respiratory motion on the displacement of target area and to analyze the discrimination between free breathing and active breathing control (ABC) in patients with gastric cancer treated with post-operative radiotherapy. Methods From January 2005 to November 2006, 22 patients with post-operatively confirmed gastric cancer were enrolled in this study. All diseases were T_3/ N +, staging Ⅱ - Ⅳ. Patients were CT scanned and treated by radiation with the use of ABC. Image J software was used in image processing, motion measurement and data analysis. Surgical clips were implanted as fiducial marks in the tumor bed and lymphatic drainage area. The motion range of each clip was measured in the resultant-projection image. Motions of the clips in superior-inferior (S-I), right-left (R-L) and anterior-posterior (A-P) directions were determined from fluoroscopy movies obtained in the treatment position. Results The motion ranges in S-I, R-L and A-P directions were 11.1 mam, 1.9 mm and 2.5 mm (F = 85.15, P = 0. 000) under free breathing, with 2.2 mm, 1.1 mm and 1.7 nun under ABC (F = 17.64, P = 0. 000), and the reduction of motion ranges was significant in both S-I and A-P directions (t = 4.36, P = 0. 000;t = 3.73,P = 0.000). When compared with under free-breathing, the motion ranges under ABC were kept unchanged in the same breathing phase of the same treatment fraction, while significant increased in different breathing phase in all three directions (t = - 4.36, P = 0. 000; t = - 3.52, P = 0.000; t =-3.79, P = 0. 000), with a numerical value of 3.7 mm, 1.6 mm and 2.8 mm, respectively (F = 19.46, P = 0. 000) . With ABC between different treatment fractions , the maximum displacements were 2.7 mm, 1.7 mm and 2.5 mm for the centre of the clip cluster (F =4.07,P =0. 019), and were 4.6 mm, 3.1 mm and 4.2 mm for the clips (F =5.17 ,P =0.007). The motion ranges were significant increased in all the three directions (t = - 4.09, P=0.000 ; t =-4.46, P = 0.000 ; t = - 3.45, P =0.000). Conclusions In the irradiation of post-operative gastric cancer, the maximum displacement of organ motions induced by respiration is in S-1 direction and the minimum in R-L direction under free breathing. The use of ABC can reduce the motions significantly in S-I and A-P directions, and the same changes exist in both inter-and intra-fraction treatment.

Objective To discuss the treatment of renal or adrenal tumor with cancer thrombus in the inferior vena cava. Methods From Jan 1984 to Apr 2008,29 cases of renal or adrenal malignancy with thrombosis involving the inferior vena cava underwent treatment.The diagnoses were confirmed by Doppler uhrasonography,CT and MRI.In the 29 surgical patiens the tumor thrombus was level I in 7,level Ⅱ in 10,level Ⅲ in 8 and levelⅣin 4.According to TNM classification,23 cases were classified to T2N.M.,1 case was T2Nl Mo,1 case was TzNlMl,1 case was T3NoMo,2 case were T3NlMl and 1 case was T3N2Mo.The mean tumor size was 8.7(4.O-16.O)cm in diameter.The mean tumor thrombosis length was 3.2(2.5-4.0)cm in level I,5.3(4.5-6.0)cm in level Ⅱ,8.2(6.5-9.O)cm in levelⅢand 15.1(12.0-18.5)cm in level IV. Results The operation was performed succesgfullv in 29 patients Patholocieal examination showed that 18 cases of clear cellcarcinoma,3 cases sarcomatoid carcinoma,2 cases renal papillary adenocarcinoma,1 case renal cell carcinoma (undifferentiated),1 case granule carcinoma,3 cases adrenocortical carcinoma and 1 case metastatic malignant melanoma of adrenal gland.Of 29 patients,3 were out of contact.Twenty-six patients were followed up for 35(0-62)months after treatment,3-and 5-year survival rates were 15/26 and 11/26.Three-year survival rates for stage T2 and T3 were 14/22 and 1/4.Five-year survival rates for stage T2 and T3 were 10/22 and 1/4.Three-year survival rates for level I、Ⅱ、Ⅲ andⅣ were 4/6,5/8,5/8 and 1/4.Five-year survival rates for level I,Ⅱ、Ⅲ andⅣ were 3/6,4/8,3/8 and 1/4.Three-year survival rates for a tumor thrombus in the below or above diaphragm were 14/22 versus 1/4,5-year survival rates were 10/22 versus 1/4.Three-year and 5-year survival rates for the patients without distant metastases and lymph node involvement were 12/18 and 9/18.Three-year and 5-year surviral rates for the patients with distant metastases and lymph node involvement were 3/8 and 2/8.The 3 surgical patients with metastatic disease died at 6,10,22 months. Conclusions Surgical treatment could be the preferred approach for the patients of renal or adrenal tumor with cancer thrombus in the inferior vena cava without distant metastases and lymph node involvement.It could improve the quality of life and may prolong survival.

Objective To quantitatively analyze the image quality of megavoltage cone-beam CT (MVCBCT) under different scanning conditions to provide reference in clinical applications. Methods Si-emens ONCOR linear accelerator with MVCBCT was used to scan the phantom under different conditions. The image quality was evaluated in terms of image noise, uniformity, spatial resolution, contrast resolution, the number of Monitor Units(MUs) used in imaging,and the size of the reconstruction matrix. The comparison of the image quality between MVCBCT and conventional simulator CT was also analyzed. Results The image noise was decreased with the increase of the number of MUs. The uniformity index showed that the system u-niformity was weakly dependent on MU numbers or the size of the reconstruction matrix. Except for the ima-ges with 5 MUs,all other images had the spatial resolution of 0.4 lp/mm with a reconstruction matrix of 256 ×256. Better low contrast resolution was achieved by using more MUs. For typical pelvis and head-and-neck patients,the imaging dose at the center was 0.8 cGy/MU and 0.7 cGy/MU, respectively,and the maxi-mum dose was about 1.2 cGy/MU. For typical abdomen patients,the image maximum dose and center dose was 1.3 cGy/MU and 0.7 cGy/MU,respectively. Conclusions The image quality of MVCBCT is inferior to the conventional kilo-voltage CT. However,with the optimization of the parameters in imaging,we can a-chieve sufficient image contrast in the bone,air and some soft-tissue structures with low imaging dose to pa-tients. Such images can be used for IGRT.