Objective To investigate the treatment effects and toxicities of extended-field intensity modulated radiation therapy (EF-IMRT) and intra-cavitary brachytherapy combined with chemotherapy for stage Ⅰ b1-Ⅳa cervical cancer with positive para-aortic lymph nodes.Methods A total of 46 stage Ⅰ b1-Ⅳa cervical cancer patients with positive para-aortic lymph nodes treated at Fudan University Shanghai Cancer Center between 2009 and 2011 were reviewed.Neoadjuvant,concomitant and adjuvant chemotherapy with paclitaxel and carboplatin were administrated for one cycle before radiation therapy,two cycles during radiation therapy or three cycles after radiation therapy.All patients received EF-IMRT and intra-cavitary brachytherapy.The positive lymph nodes received an additional boost dose.Results All patients received EF-IMRT to 50.4 Gy (1.8 Gy per fraction).Twenty-six patients was treated with boost dose of 6.0-8.0 Gy in 2.0 Gy per fraction to positive para-aortic lymph nodes.Thirty-seven patients received a positive paraaortic lymph nodes boost or(and) parametrial boost.All patient also received a high-dose-rate intra-cavitary brachytherapy at the point A dose of 20.0-30.0 Gy in 5.0 Gy per fraction.Total chemotherapy cycles were 189,and the average patient received 4.1 courses.Two cases (4％,2/46) experienced grade Ⅲ gastrointestinal toxicities,no patients suffered grade Ⅳ gastrointestinal toxicities.Fifteen cases (33％,15/46) experienced grade Ⅲ hematological toxicities,and 3 (7％,3/46) experienced grade Ⅳ hematological toxicities.Late grade Ⅲ-Ⅳ toxicity was seen in 3 cases (7％,3/46).The 3 year progressionfree survival rate was 46.2％,and the 3 years overall survival rate was 61.2％.Conclusion EF-IMRT and intra-cavitary brachytherapy combined with chemotherapy is safe and effective for stage Ⅰ b1-Ⅳa cervical cancer with positive para-aortic lymph nodes.

Objective To establish the proper review rules for the microscopic screening of urine samples tested by automatic urinalysis work station.Methods A total of 3 154 random urine samples were enrolled to establish and validate review rules .All the samples were collected from the inpatients and outpatients of Shanghai First People′s Hospital from March to May 2013 and tested by urinalysis work station.Three thousands one hundred and fifty four urine samples were firstly tested by urinalysis work station,including both urine dry chemical analyzer and urine sediments analyzer .Then each urine sample was examined microscopically by two technicians-in-charge using double-blind method.The average results from the two technicians were used as review results .Compared with review results ,the review rules were set up.According to different test methods by automatic urinalysis work station , four microscopic review protocols were defined:(1)Protocol 1:based on chemistry results only ,microscopy review was performed when any of WBC,RBC,PRO and NIT was positive;(2)Protocol 2:based on urine sedimental analysis only ,microscopy review was performed when any of WBC ,RBC and CAST count was over upper limit of the reference range;(3)Protocol 3:if any of BLD ,RBC,LEU,WBC was different between two systems ,or quantitative results had two or more than two gradient differences ,microscopy review was performed;(4) Protoco1 4:if any of BLD, RBC,LEU ,WBC was different between two systems , or CAST was over upper limit of the reference range , or alarm appeared , microscopic review was performed .400 randomly selected urine samples were tested to validate the review rules .Omission diagnostic rate and review rate were used to evaluate the rules .Results According to the review rules,the positive samples rate was 43.47%(1 371/3 154) and the negative rate was 56.53%( 1 783/3 154 );Positive samples were composed of RBC ( 55.58%) , WBC ( 59.66%) and CAST(6.42%).The review rates of four protocols were 44.48%(1 403/3 154),45.69%(1 441/3 154), 26.09%(823/3 154),28.95%(913/3 154),respectively.The false negative rates (omission diagnostic rates)were 7.13%(225/3 154),4.53%(143/3 154),2.73%(86/3 154) and 1.02%(32/3 154), respectively .Protocol 4 was selected as an ideal plan.Additional 400 urine samples were tested using protocol 4 in order to confirm the review rule.The review rate, false negative rate were 26.25%(105/400), 0.75%( 3/400 ), respectively.After image review revised, the review rate was 14.50%(58/400).Conclusion This study formulates that the automatic urine analysis workstation review rules have clinical maneuverability and validity.

AIM:To study the effect of dexamethasone(Dex)on the expression of aquaporin-1(AQP-1)in cultured rat pleural mesothelial cells and to offer experimental support for the investigation of the mechanisms of pleural fluid treatment.METHODS:Rat pleural mesothelial cells were cultured in vitro.The expression of AQP-1 was detected by immunocytochemistry and reverse transcription-PCR(RT-PCR)after cells were identified,then the cells were treated with Dex for 24 hours at concentrations of 10-8,10-7,10-6,10-5 and 10-4mmol/L,and for 6 h,12 h,24 h,36 h,48 h,72 h at concentration of 10-4 mmol/L.Western blotting was used to analyze the expression of AQP-1 in cultured control and Dex-treated rat pleural mesothelial cells,and image analysis system to analyze the expression of AQP-1.RESULTS:Aquaporin-1 was expressed in cultured rat pleural mesothelial cells.The protein of AQP-1 expressed in rat pleural mesothelial cells was 755.04?19.81,843.72?19.41,862.96?26.53,694.80?32.00,938.08?13.32 in those treated with Dex at concentrations of 10-8,10-7,10-6,10-5 and 10-4 mmol/L,respectively,the levels was 2.02,2.26,2.31,1.86,2.52 fold higher than that in control group(372.90?16.46,P

Objective To investigate the distribution, isolation and culture of the epidermal stem cells from rats. Methods Immnohistochemical methods were used to confirm the location of the epidermal stem cells. The skin of neonatal rats were dissociated into single cells by dispaseⅡ and trypsin solution,the rapidly adherent cells to collgenⅣ were cultured with KSFM,and those no rapidly adherent cells were regarded as control. Immunohistology and flow cytometry were conducted to identify the epidermal stem cells. Results ? 6-integrin and K15 were expressed in the basal layer cells and hair follicle bulge cells, while the CD71 was negative negatively expressed. CD34 were expressed in the hair follicle bulge cells while not in the basal layer cells. The epidermal stem cells isolated by collgenⅣ had higher colony forming efficiency. Immunocytochemical staining showed that ? 6-integrin and K15 were strongly expressed in the cultured epidermal stem cells. Flow cytometry indicated that 84% cultured epidermal stem cells were expressed ? 6-integrin. Conclusion The epidermal stem cells of rats are located at the basal layer of epidermis and the hair follicle bulge.

BACKGROUND:Recently,with the rapid development of material science and bioscience,the technology of dental implant has made great progress,especially the immediate implant technology.But the size and shape of implant are usually not fit for tooth extraction wound,so it is an important factor that leads to failure when implant and tooth extraction wound can not form close tangency.Guided bone regeneration or bone grafting materials are usually used to solve this problem.OBJECTIVE:To study the effects of nano-hydroxyapatite/collogen (nHAC) with recombinant human bone morphogenetic protein-2(rhBMP-2) and titanium (Ti) membrane on repairing peripheral bone defects of instant implant.DESIGN,TIME AND SETTING:A randomized,controlled animal study was performed at the Central Laboratory,the Fourth Military Medical University of Chinese PLA between January 2005 and January 2006.MATERIALS:Ti screw implants (diameter 2 mm,length 10 mm,and pitch 0.4 mm) without the part that went through gum were offered by Nonferrous Metal Academy in Baoji,China.The nonabsorbable Ti membranes (2 cm×2 cm) were offered by Zhongbang Biomaterial Limited Company in Xi'an,China.The nHAC materials were gifted by professor Cui Fu-zhai from Material Science and Engineering Department of Tsinghua University and fabricated into 0.5 mm×0.5 mm×0.5 mm small blocks.rhBMP-2 was offered by the Academy of Military Medical Sciences in Beijing,China.rhBMP-2 was dissolved with hydrochloric carbamidine and then nHAC was immersed in it.Vacuumization,freeze-drying,and Ekibon degermation were followed.Each gram of nHAC compounds required approximately 1 mg rhBMP-2.METHODS:Four healthy purebred male dogs were included in this study.According to the methods to repair bone defects rhBMP-2+Ti membrane,nHAC composited with rhBMP-2 was implanted,covering Ti membrane.Six defects were made on the mandible on each side.MAIN OUTCOME MEASURES:At 6 and 12 weeks after implantation,new bone formation and the correlation of new bone to Ti implant were investigated by radiography,bone density measurement and histological examinations.RESULTS:All the bone wounds were full of new bone at 12 weeks,the Ti implants were steady and the osseointegration was good.In the nHAC+rhBMP-2 and nHAC+rhBMP-2+Ti membrane groups,new bone formed and maturated earlier.In the nHAC +Ti membrane,blank control,and nHAC + rhBMP-2 +Ti membrane groups,new bone formed well below Ti membrane and the alveolar crest was plump.In the nHAC + rhBMP-2 +Ti membrane group,new bone formed earliest with the most quantity and the alveolar crest was the plumpest.By 12 weeks,the bone density had achieved the same level as the autologous cancellous bone transplantation,but the alveolar crest was plumper compared to the positive control group.In addition,bone mass was much more.Bone formed slowest in the blank control group and fastest in the positive control group with the crest of ridge being slightly absorbed.CONCLUSION:nHAC is a new good bone graft material in repairing peripheral bone defects of instant implant,especially compositing with rhBMP-2 and/or Ti membrane.A round method to repair the surrounding bone defect of instant implant should be selected according to the specific situation in the clinic.

The authors analyzed the status quo of the indicators, outcomes and uses,methodology, procedures and technologies of the variations management of clinical pathways in China the abroad. The outputs of the study point to the following assignments in such a management, such as further identification of the contents of such variations, and further clarification of variation analysis indicators.

Objective To find out present condition and differences in implementation of clinical pathways in hospitals of in China.Methods "Clinical pathway" was entered as a keyword to search in PubMed NCBI Chinese Science and Technology Periodical Database for related literatures in China from 1999 to 2009,analyzing the general implementations of clinical pathways in hospitals in different areas using the SPSS12.0 software.Results A total of 1051 relevant literatures were found.Through data analysis of these literature,differences of implementation of clinical pathways were found for 162 hospitals of different areas.It was found that the differences of total diseases among China's East,West and Central areas are significant statically.Diseases of implementation per hospital in the Central average 16.8,those in the East 8 types,while those for the West 4.4.Tertiary hospitals account for 70% as the main force of clinical pathway implementation,with diseases of implementation up to 13.7,while that under tertiary level down to 2.8.Conclusions Implementation of clinical pathways varies significantly among hospitals in different areas in China.In the process of implementing clinical pathway,appropriate management strategies should be developed according to actual situation in different hospitals in light of policies,hospital management and patient considerations.

Objective To investigate the role of norepinephrine in the down-regulated visceral sensitivity of rats deprived of rapid eye movement(REM)sleep.Methods Twenty-four male Sprague- Dawley rats were randomly divided into 3 groups:cage-yoked rats as control(YC),rats with REM sleep deprivation(SD)and rats with yohimbine administered intraperitoneally after REM sleep deprivation(YSD).Flower pot technique was employed to make sleep deprivation model.YSD group was given vohimbine intraperitoneally at the 48th hour after REM sleep deprivation.After both SD and YSD groups had completed these processes,rats of all the three groups were given colorectal distension(CRD)and electromyogram (EMG)was recorded at the same time.The number of discharges of EMG and the threshold of Dain perception of the rats were observed to evaluate the visceral sensitivity.The thalamus,rectum and distal colon were taken after CRD;MAO-mRNA and TH-mRNA in three tissues were detected with RT-PCR.Resuits On 48th hour,the number of discharges of EMG in 10 seconds responding to CRD in group SD was significantly less than that in group YC and the threshold of pain perception in group SD was higher than that in group YC(P＜0.05).The number of discharge of EMG in group YSD was significantly more than that in group SD(P＜0.05).The expression of MAO-mRNA in group SD was lower than that in group YC(P＜0.05)and the expression of TH-mRNA in group SD was higher than that in group YC(P＜ 0.05).Conclusions The visceral sensitivity in rats is down-regulated by REM sleep deprivation,which can increase synthesis of norepinephrine.Norepinephrine can modulate visceral sensitivity.

Implementation of clinical pathways has a natural tie with payment modes of medical insurance,as various payment modes apply different impacts on clinical pathway.This article compared the strengths and weaknesses of various payment modes,and analyzed their impacts on clinical pathway.This way the authors provide references for decision makers of medical insurance policy.

Objective To study the expression of Adiponectin (AD) and its receptors Adiponectin receptor 1 (Adipo R1) and Adipo R2 in the synovial fluids and the synovium of rheumatoid arthritis (RA). Methods ELISA was used to determine the levels of AD in 23 RA and 23 osteoarthritis (OA) patients. Real-time PCR and Western blot techniques were employed to study the expression of AD, AdipoR1 and AdipoR2 in the synovium of 10 RA and OA patients. Results It was observed that approximately twice more adiponeetin in the synovial fluids of patients with RA than with OA. Adiponectin and AdipoR1, but not AdipoR2 mRNA, were significantly expressed in synovium of RA patients in comparison with OA. Adiponectin and AdipoR1 protein were wuch more expressed in synovium from RA than those from OA. Conclusion High expression of Adiponectin and AdipoRl is likely to contribute to the formation of inflammatory joints in RA.