Objective To evaluate the efficacy of the intensity modulated radiotherapy in early stage cervical cancer with vaginal stump recurrence after surgery.Methods A retrospective concurrent comparative study included 60 patients with vaginal recurrence after surgery in early stage cervical cancer.30 cases of the experimental group were treated with intensity-modulated radiotherapy (IMRT),and 30 cases of the control group were treated with conventional radiotherapy.The efficacy and complications between two groups were compared after 3 treatment cycles.Results Of 30 patients in experimental group,22 patients achieved complete remission,7 had partial and 1 progressed.But in the control group,14 had complete remission,5 reached partial remission,7 were stable and 4 progressed.The effective rates were 96.67 ％ (29/30) and 63.33 ％ (19/30),respectively,in the experimental and control group,which showed statistical significance (P =0.009).In the experimental group,there were 1 case with grade 1 radiation cystitis and 1 case with grade 1 radiation proctitis.In the control group,there were 3 cases of vaginal-rectal fistula,1 case of grade 3 radiation proctitis,2 cases of grade 2 radiation cystitis and 2 cases of grade 1 radiation proctitis.Conclusions IMRT for treating vaginal recurrence of early cervical cancer achieves satisfactory short-term effect.In comparison with conventional radiotherapy,IMRT has higher efficacy but less side effects.

Objective To learn and evaluate the present prescriptions from outpatient departments of 21 public hospitals in Songjiang district,and to promote rational drug use.Methods A total of 75,600 outpatient prescriptions from 21 public hospitals in Songjing district were collected monthly from January 2008 to October 2010 and analyzed statistically using indexes for prescription evaluation.Results of the 75,600 prescriptions,the types of drugs in each prescription averaged 2.35,the ratio of antibiotics use and injection agents use were 35.77％ and 17.40％,respectively.The percentage of essential drugs without added profit accounted for 41.91％ of the total drug use,and the average drug cost per prescription was RMB 85.99.Comparison of indexes for prescription evaluation showed that the ratio of antibiotics use and injection agents use as well as the average cost per prescription in secondary hospitals were significantly higher that those in community health centers (P＜0.01),while the percentage of essential drugs without added profit and the average number of drugs in each prescription were statistically smaller than those in community health centers (P＜0.01).Conclusion Drug use in outpatient departments of 21 public hospitals was rational in general,especially noteworthy is the significant improvement made at community health centers in recent three years.

Objective To compare the dosimetry and toxicities between postoperative fixed-field intensity-modulated radiotherapy (FF-IMRT) and image-guided radiation therapy/volumetric modulated arc therapy (IGRT-VMAT) for cervical cancer.Methods A total of seventy patients with stage I b-Ⅱa postoperative cervical cancer who had high risk factors,were divided into FF-IMRT (FF-IMRT group,n =35)and IGRT-VMAT (IGRT-VMAT group,n =35),to compare the difference of target dose and adverse reaction between the two groups.Results In the IGRT-VMAT group,the interfractional setup errors in the x,y,and z axes were (0.25±0.14) cm,(0.26±0.16) cm,and (0.24±0.18) cm,respectively;the intrafractional setup errors in the x,y,and z axes were (0.1±0.09) cm,(0.12±0.09) cm,and (0.11±0.09) cm,respectively;the margins in the x,y,and z axes were 0.75 cm,0.84 cm,and 0.78 cm,respectively.Under the same dosimetric conditions,the IGRT-VMAT group was superior to the FF-IMRT group in terms of conformity index,treatment time,and number of monitor units (P=0.000).The Dmean and volume receiving high-dose irradiation for the bladder,rectum,and small intestine were significantly lower in the IGRT-VMAT group than in the FF-IMRT group (P=0.000).Compared with the FF-IMRT group,the IGRT-VMAT group had a significantly reduced incidence of acute and chronic gastrointestinal,urinary,and hematologic toxicities (P＜ 0.05).Conclusions IGRT-VMAT can correct setup error online,shorten the treatment time,reduce the dose to organs at risk,and alleviate acute and chronic toxicities,and is especially suitable for patients with postoperative small bowel position changes.

BACKGROUND: It has been proved that electromagnetic field can adjust and control proliferation and differentiation of bone marrow mesenchymal stem cells v/a cyclic adenosine monophosphate (cAMP)-protein kinase A (PKA) signal transduction system. However, there are few relevant reports about Ca2+ as the second messenger in application. OBJECTIVE: To study the effects of verapamil on the proliferation and differentiation of bone marrow rnesenchymal stem cells stimulated by electromagnetic fields and to conclude influx changes of Ca2+.DESIGN, TIME AND SETTING: Electrostimulative cytological observation in vitro, which was performed in Laboratory of Orthopedic Surgery, Tongji Hospital between April and June 2005.MATERIALS: Six 4-5-week SD rats of clean grade were selected in this study. Verapami| was provided by Sigma Company, USA, and Helmholtz coil-magnetic field producer was made in Department of Electric Machine, Navy Engineering University.METHODS: The bone marrow mesenchymal stem cells were isolated and cultured in vitro with adherence method and digested with trypsin. The fourth-passage cells were harvested, adjusted to 1 × 107 L-1 in density, and divided into A, B, C and D groups in 96-well plate with 200 μ I/well. Cells in the normal control group were not performed with any agent. On the second day of inoculation, cells in the magnetic field (EMF) group were cultured in Helmholtz-coil magnetic field (0.8 mT, 50 Hz) in 0.05% CO2 saturated humidity incubator at 37 ℃, 30 minutes for each, 12 hours for interval, six time in total. Cells in the verapamil group were cultured with 20 μ mol/L verapamil, and cells in the combination group were cultured with 20 μ mol/L verapamil and magnetic stimulation.MAIN OUTCOME MEASURES: Proliferative activity was tested with MTT method, content of alkaline phosphate differentiated to osteoblasts was measured, and cells were stained with modified Gomori Ca-Co staining. RESULTS: Proliferative activity was significantly increased in the EMF group as compared with that in the normal control group after 3-day magnetic stimulation (P < 0.01), but verapamil could inhibit promotive effect on proliferation. Content of alkaline phosphate in the normal control group was similar to that in the EMF group, while those two contents were significantly higher than those in the verapamil group and the combination group (P < 0.01); furthermore, content of alkaline phosphate in the combination group was significant higher than that in the EMF group (P < 0.01). Qualitative analysis of alkaline phosphate showed a coincident result as mentioned above.CONCLUSION: EMF of 50 Hz frequency and 0.8 mT intensity can change intracellular free calcium ion concentration of bone marrow mesenchymal stem cells, and the change play a key role in the cellular proliferation and play a partial role in the differentiation of bone marrow mesenchymal stem cells into osteoblasta.

Objective To investigate the efficacy and toxicity of concurrent chemoradiotherapy with nedaplatin versus cisplatin for patients with middle-advanced stage uterine cervical carcinoma.Methods 180 patients with middle-advanced stage uterine cervical carcinoma were randomized into concurrent chemoradiotherapy with nedaplatin group (nedaplatin group) and concurrent chemoradiotherapy with cisplatin group (cisplatin group).The short-term efficacy and the toxicity were observed.Results In the nedaplatin group,the short-term response rate、the one-year relapse-free surviva l、one-yea metastasis-free survival、the two-year relapse-free survival、the two-year metastasis-free survival were 98.85％、89.66、86.21％ 、85.06％ 和 80.46％,But in the cisplatin group,the short-term response rate 、the one-year relapse-free surviva l、one-yea metastasis-free survival、the twoyear relapse-free survival、the two-year metastasis-free survival were 97.60％ (x2 =3.07,P ＞ 0.05) 、81.93％(x2 =3.07,P ＞0.05) 、83.13％ (x2 =0.31,P ＞0.05) 、78.31％ (x2 =1.30,P ＞0.05) 和 80.72％ (x2 =0.00,P ＞ 0.05),so there was no significant difference.The incidences of nausea and vomiting in the cisplatin group were 52.27％ (grade Ⅰ ～ Ⅳ toxicities),12.50％ (grade Ⅲ ～ Ⅳ toxicities),which were higher than those in the nedaplatin group 27.27％ (grade Ⅱ ～ Ⅳ toxicities),6.82％ (grade Ⅲ ～ Ⅳ toxicities) (P ＜ 0.05),while there were no significant difference in the other toxicities such as anemia,granulocytopenia,thrombocytopenia,diarrhoea between the two groups (x2 =12.18,P ＞ 0.05).Conclusion The efficacy of concurrent chemoradiotherapy with nedaplatin is the same as that of concurrent chemoradiotherapy with cisplatin,and its toxicity is well-tolerated.

Objective:To explore the factors affecting the postoperative prognosis of early cervical squamous cell carcinoma and inves-tigate the different radiotherapy techniques. Methods:A total of 100 postoperative patients of early cervical squamous cell carcinoma treated in Affiliated Tumor Hospital of Xinjiang Medical University and Affiliated Tumor Hospital of Sun Yat-sen University from March to September 2013 were enrolled in our study. The prognostic factors for these patients were analyzed. After being subjected to differ-ent postoperative radiotherapy techniques, the efficacy and complications of the techniques were assessed for patients, including 50 cases of conventional radiotherapy (CRT) and 50 cases of image-guided radiotherapy (IGRT). Results:The 3-year overall survival rate was 89%, and the 3-year disease-free survival rate was 78%. The 3-year overall survival rates of the CRT and IGRT groups were 78.57%and 89.06%, respectively. The difference between these rates was statistically significant (P=0.034). The 3-year survival rates of the CRT and IGRT groups were 66.67%and 87.36%, respectively. The difference was statistically significant (P=0.042). The incidence of ear-ly and late complications in the CRT group was higher than that in IGRT group, and the difference of P<0.05 was statistically significant. Multivariate analysis showed that postoperative radiotherapy, parametrial invasion, lymph node metastasis, lymphovascular space in-vasion, perineural invasion, and deep stromal invasion were the independent risk factors for the prognosis of patients with early stage cervical squamous cell carcinoma. Conclusion:Early prognosis of cervical squamous cell carcinoma results from the interaction of mul-tiple factors. The 3-year survival rate of the IGRT group was significantly better than that of the CRT group in the early stage of cervical squamous cell carcinoma. IGRT alleviates acute and chronic toxicities and helps improve the quality of life of patients.

Objective To explore expression of plexinA1 and Ki-67 in tissue of human brain glioma cells and their clinical significance.Methods 43 specimens from patients with brain glioma were collected.Immunohistochemical (IHC) staining was used for detecting the expression of tissue plexinA1 and Ki-67 in human glioma cells of 43 cases of patients with brain glioma.The positive expression rate of plexinA1 and Ki-67 among the different pathological grade tissues and their clinical significance were analyzed.So did correlation studies about plexinA1 and Ki-67.Results The positive expression rates of plexinA1 in Ⅰ-Ⅱ grade group (18 cases) and Ⅲ-Ⅳ grade group (25 cases) were 22.22 ％ (4/18) and 72.00 ％ (18/25) (P ＜ 0.05).The positive expression rates of Ki-67 in Ⅰ-Ⅱ grade group and Ⅲ-Ⅳ grade group were 16.67 ％ (3/18) and 56.00 ％ (14/25),respectively (P ＜ 0.05).PlxinA1 and Ki-67 expression in the tissue of human brain glioma were positively correlated (r =0.997,P ＜ 0.05).Conclusions The positive expression rate of plexinA1 is higher in high malignancy human glioma group than that in low malignancy group which has an important reference value in the estimation of prognosis for human glioma.PlexinA1 and Ki-67 maybe synergism in occurrence and development of glioma.

Objective To explore the effect of acupuncture at Yanglingquan (GB 34) on white matter structure of stroke patients. Methods 6 stroke patients with left hemiplegia in recovery stage were recruited. The sham acupoint was as control, the diffusion tensor imaging (DTI) data in a 1.5 T SIEMENS scanner before and after acupuncture at Yanglingquan point was collected. Differences between the two conditions were compared with the Tract-Based Spatial Statistics (TBSS), which is one of FSL tools. Results The brain areas included left precentral gyrus, postcentral gyrus, middle temporal gyrus, inferior temporal gyrus, supplementary motor area, inferior frontal gyrus, internal capsule, fornix and bilateral inferior parietal gyrus, in which the verum acupuncture had stronger effect on fractional anisotropy (FA) than the sham acupuncture. White matter tract such as pyramidal tract, arcuate fasciculus, corpus callosum and other inter-cortex association fibers passed these brain areas. The fiber tracts and brain areas were found to be involved with multiple brain networks of motor compensation, somatosensory, language and cognition. Conclusion Compared with the sham point, acupuncture at Yanglingquan point can change the microstructure of stroke patients' white matter, mainly in the inaffected side and related to multiple functional networks.

Objective To evaluate the potential risk of aorta injury by simulating different lateral misplacement patterns of thoracic pedicle screws (TPS) in the treatment of adolescent idiopathic scoliosis (AIS).Methods From December 2010 to August 2011,50 AIS patients were admitted to our hospital,including 7 males and 43 females,aged from 13 to 18 years (average,15.3±2.6 years).All patients underwent axial magnetic resonance imaging (MRI) scans from T5 to T12.The left pedicle-aorta (LtP-Ao) angle and distance were measured on the axial MR images by the software of PACS Client.The lateral misplacement of pedicle screw was simulated with variable direction errors (10°,20°,30°) and different lengths of pedicle screw (30 mm,35 mm,40 mm).A total of nine patterns of lateral pedicle screw misplacement were set up,and a warning misplacement was defined as the mimic pedicle screw crossed the aorta.The percentages of warning misplacement were compared in each pattern of lateral pedicle screw misplacement and each level from T5 to T12.Correlation analysis was made between the percentages of warning misplacement and the direction errors as well as length of pedicle screw.Results The mean LtP-Ao angle increased from 34.3°±8.5° at T5 level to 45.7°±4.1° at T7 level,and then gradually decreased to 9.2°±5.6° at T12 level.The mean LtP-Ao distance increased from 28.2±7.3 mm at T5 level to 37.7±6.5 mm at T12 level.The percentages of warning misplacement were positive correlation with the direction errors and length of pedicle screw.The percentage of warning misplacement was higher at the T11 level.Conclusion The potential risk of aorta injury increases with enlarging of direction error and lengthening of thoracic pedicle screw,particularly at the T11 level.

Objective To investigate the significance of 25 hydroxyvitamin D3 (25 (OH)D3) in patients with type 2 diabetes mellitus by comparing the differences of serum 25-hydroxyvitamin D levels between type 2 diabetes mellitus patients and healthy people.Methods One hundred and forty-seven patients with type 2 diabetes mellitus were selected as the T2DM group,and 135 healthy people were selected as the normal control (NC) group.The level of serum 25 (OH) D3 was detected by ELISA.Clinical data were recorded and biochemical indexes were also detected.Statistical analysis was performed.Results (1) Serum 25 (OH) D3 level in T2DM group was low,but there was no significant difference between two groups((23.10 ± 1.59) μg/L vs.(23.11 ± 1.65) μg/L; t =0.064,P =0.949),as well as between men and women in the 2 populations (T2DM men vs.women(23.22 ± 1.54) μg/L vs.(22.95 ± 1.65) μg/L; t =0.209,P ＞0.05; NC men vs women(23.03 ± 1.73) μg/L vs.(23.18 ± 1.59) μg/L; t =0.436,P ＞0.05) ; (2)The prevalence of vitamin D insufficient and deficiency in T2DM group was high,but it was not statistically significant between two groups (98.0％ vs.94.8 ％ and 2.0％ vs.5.2％ ; x2 =2.034,P =0.154) ; (3) Serum 25 (OH) D3 in T2DM group has a significant negative correlation with triglycerides (r =-0.218,P ＜ 0.01).Conclusion (1) Vitamin D level was low in both the healthy and T2DM populations in the southern region of China,the prevalence of vitamin D insufficient and deficiency was up to 90％.(2)Triglyceride is the only independent risk factor to T2DM population.