Objective To study the influence of volume change of tumor bed on radiotherapy dose volume distribution after breast conserving surgery for early breast cancer.Methods 13 early breast cancer patients received breast-conserving surgery were selected.For all 3 CT scanning in patients with tumors,row delineation of tumor and normal tissue target positioning,the tumor bed after volume as well as the planned radiation dose volume were compared in three times of scans.Results 13 cases of three CT scans of patients with tumor bed volume point to (32.85±9.30)cm3,(24.50±4.71)cm3,(16.48±4.46)cm3,there were statistically significant differences before and after(t=2.888,5.723,4.458,all P<0.05);3 planned radiation dose in patients with volume was stepped down,and the differences were statistically significant (F=20.28,96.32,14.21,16.75,26.29,all P<0.001).Conclusion Earlier the tumor bed following breast surgery volume decreased rapidly,tumor volume change will affect the target area of the bed covers and the exposure of normal tissue dose-volume.

Objective To discuss the application effect of lateral prone position in the left trigeminal nerve root microvascular decompression on the degree of compression on axillary nerve and arm discomfort,in order to supply evidence for selection of a suitable position during trigeminal nerve root microvascular decompression.Methods 44 cases who underwent microvascular decompression of trigeminal nerve roots were randomly divided into the observation group and the control group with 22 cases in each group.They were in lateral prone position with their arms placed in different positions.The influence on arm function was observed in two groups.Results The arm feeling,response to pain,the upper limb swelling and flexibility were statistically significant between two groups.Conclusions For lateral prone position arrangements during microvascular decompression of trigeminal nerve root,the patients' head should be moved ahead,the right arm should be out of bed and be fixed in a lower position,so that nerve and functional damage can be prevented by avoiding decompression of the right upper arm.

The interaction of 5-fluorouracil (5-FU) with deoxyribonucleic acid (DNA) and serum albumin and the influence of some metal ions on the interaction have been studied by using spectral methods of UV-absorption,fluorescence and circular dichroism. It was shown that the interaction of 5-FU with DNA and serum albumin was effected by some metal ions. The binding costant of 5-FU with serum albumin was found to be KHSA = 4.38 × 103(mol/L)-1 and KBSA =4.95 × 103(mol/L)-1 and the distance between the bound 5-FU and the tryptophan residue was also determined to be rHSA = 3.53 nm, rBSA = 3.51 nm.

Professor LAI Xinsheng's treatment experience of infertility mainly by Tongyuan needling technique for both females and males is summarized. Tongyuan needling technique is a treatment method of leading qi to its primordial location mainly through viscera back-shu points that can dredge the governor vessel and tonify the spirit and conception vessel points in abdomen and abdominal front-mu points, and according to state of illness acupoints for opening the 4 gates or five shu points are combined; reinforcing and reducing manipulations of acupuncture are applied for reference. With the method of listing cases, professor LAI Xinsheng's Tongyuan needling technique is detailedly introduced in different aspects, such as the treatment of polycystic ovary syndrome infertility and male infertility and improving the success rate of test-tube baby, and the manipulation of Tongyuan needling technique is summarized, indicating that Tongyuan needling technique is worth vigorously prompting in clinical treatment of infertility.
Acupuncture Points ; Acupuncture Therapy ; Adult ; Female ; Fertilization in Vitro ; Humans ; Infertility ; Male ; Meridians

In this paper,a unique case of organ transplantation was inspected by organ transplant ethics committee,through which we try to investigate the mode of current operation,problems and confusion of organ transplant ethics committee in China by the constitutive principles,inspection scope,process,content,especially the functional authority and other relevant contents of hospital ethics committee.

This paper describes the role,method and experience,and working model of medical ethics in large-scale hospitals,and holds that the modern hospital management mode has transformed from scientific management to humanism-based management,whose essence is the transformation of managing concept,and the embody of management ethics and management culture.Important connotations and primary task including employing virtue in hospital management,obeying legal regulations in medical practice,and conducting humanistic medicine should be emphasized and concerned in hospital management.

Objective To evaluate the role of extracellular signal-regulated kinase (ERK) signaling pathway in morphine-or sufentanil-induced inhibition of arrhythmia induced by myocardial ischemia-reperfusion (I/R) in rats and the relationship with connexin43 (Cx43).Methods Forty-eight healthy SPF adult male Sprague-Dawley rats,weighing 200-300 g,were randomly divided into 6 groups (n=8 each) using a random number table:sham operation group (group S);I/R group;morphine group (group M);sufentanil group (group Suf);morphine + ERK inhibitor PD98059 group (group MP);sufentanil + PD98059 group (group SP).Myocardial ischemia was induced by 30 min occlusion of the left anterior descending branch of the coronary artery,followed by reperfusion.In M and Suf groups,the animals were subjected to three cycles of 5-minute drug infusion (morphine 0.3 mg/kg and sufentanil 3 μg/kg,respectively) via the femoral vein interspersed with 5-minute drug-free periods starting from the time point immediately before ischemia.PD98059 10 mg/kg was injected intravenously at 10 min before ischemia in MP and SP groups.The development of ventricular arrhythmia was recorded within 30 min of ischemia and 30 min of reperfusion,and the arrhythmia was scored (AS).The animals were then sacrificed at 120 min of reperfusion,and the myocardial specimens were obtained for determination of the expression of total Cx43 (t-Cx43),phosphorylated Cx43 (p-Cx43),and phosphorylated ERK (p-ERK) by Western blot.Results Compared with group S,the AS was significantly increased,and the expression of p-Cx43 was significantly down-regulated in the other groups,and the expression of t-Cx43 and p-ERK was significantly down-regulated in I/R,SP and MP groups (P＜0.05).Compared with group I/R,the AS was significantly decreased,and the expression of t-Cx43,p-Cx43 and p-ERK was significantly up-regulated in M and Suf groups (P ＜ 0.05).Compared with M and Suf groups,the AS was significantly increased,and the expression of t-Cx43 and p-Cx43 was significantly down-regulated in SP and MP groups (P ＜ 0.05).Conclusion The mechanism by which morphine or sufentanil inhibits arrhythmia induced by myocardial I/R is associated with up-regulated expression of myocardial Cx43 after activation of ERK signaling pathway in rats.

Objective To investigate the mobility of the lung tumors in order to guide the margin that CTV is to be expanded to PTV during stereotaetic radiotherapy for lung tumors.Methods Eighty-three lung tumom ineluded,in which 7 invaded the chest wall.1-2 gold marker(s)was/were implanted into or nearby the tumor.The motion of lung tumors in x(right-left),y(superior-inferior)and:(anterior-posterior)directions were measured via X-ray simulator system.One week later,1.25 mm thick of 16-slice spiral CT lung scan were taken.Apex,middle,and bottom of the lung were classified according to anatomic boderlines.Results No significant difference was detected among movements of apex,middle and bottom of the lung lesions in x axis direction((1.6±0.8),(2.6±1.1),(2.8±1.7)mm,respectively(F=1.76,P=0.179))and,y axis direction((2.0±1.3),(4.3±2.8),(4.0±2.0)mm,respectively(F=2.06,P=0.135))in 76 lesions of 63 patients.Significant differences were detected in:axis((2.7±0.8),(7.3±3.6),(12.0±5.3)mm(F=16.33,P=0.000)).The mobilities of the 7 lesions of 7 patients invading the chest wall were very small in all directions(0.9±0.7,0.7±0.7.and 2.0±0.6 mm,respectively).Motion amplitude did not correlate with the sex,age,height,weight and FEV1/FVC(r=-0.001-0.136.all P>0.05).Conclusions Motion amplitude of lung tumor due to breathing is associated with tumor loeation and status of chest wall invoivement.Identification of the mobile rules and the influencing factors is important for the internal margin set-up in lung tumor radiotherapy.

Objective To investigate the antimicrobial resistance mechanisms and genetic homogeny of Salmonella from community acquired infections in Shenzhen,China.Methods Ninety-three of Salmonella were isolated from 2002 to 2007 at Shenzhen People's Hospital,China.PCR and DNA sequencing were used to investigate the mutation in QRDR of the gyrA,gyrB,parC and parE.Plasmid mediated quinolone resistance genes including qnr and aac(6')-Ib-cr,β-lactamase genes including blaTEM,blaSHV,blaOXA, blaCTX-M, and class 1 integron were detected. All isolates were typed by PFGE. Results S. enterica typhi and S. enterica paratyphi A were susceptible to ampicillin, chloramphenicol, trimethoprim/sulfamethoxazole, ceftriaxone and ciprofloxacin, with the susceptible rate of 96%-100%. Fifty-two percent (13/25) of S. enterica typhi and 95% (61/64) of S. enterica paratyphi A were resistant to nalidixic acid. Twenty-four percent (6/25) of nalidixic acid-resistant S. enterica typhi and 94% (60/64) of nalidixic acid-resistant S. enterica paratyphi A showed decreased susceptibility to ciprofloxacin (MIC of 0. 125-1 μg/ml).All nalidixic acid-resistant (susceptible to ciprofloxacin ) Salmonella (NARS) isolates had a single substitution in the QRDR of GyrA, and 91% (68/75) of these isolates carried the substitution Ser83Phe in GyrA. Two mutations in the QRDR of GyrA were detected in both of two ciprnfloxacin-resistant Salmonella,with the additional one mutation in the QRDR of parC. Plasmid mediated quinolone resistance genes including qnr and aac(6')-lb-cr were not detected in any isolate. The blaCTX-M-14 gene was detected in a ceftriaxoneresistant isolate of S. enterica paratyphi A, with ISEcpl located on the upstream of it. Three muhidrugresistant strains of Salmonella all carried one 1 900 bp classⅠ integron gene cassette dhfrⅫ-orfF-aadA2,with the additional one β-lactamase gene of blaTEM-1, or blaOXA-30. Twenty-two distinct PFGE patterns were observed among twenty-five S. enterica typhi. The PFGE patterns of sixty-four S. enterica paratyphi A showed limited genetic diversity (average similarity of 91% ). Ninety investigated inpatients were infected in the community. Six patients infected by S. enterica paratyphi A had a travel history before infection. Conclusions Nalidixic acid-resistant S. enterica typhi and S. enterica paratyphi A are highly prevalent in Shenzhen,China. The mutation in the QRDR of GyrA is the prevalent mechanism responsible for the resistance to nalidixic acid in Slmonella. The great genetic similarity among S. enterica paratyphi A isolates indicates endemic disease from the presence of a single clone over 6-year period.

Objective To study interdialytic body weight gain(IBWG)in maintenance hemodialysis(MHD)patients,and to analyze the associated factors. Methods A total of 269 patients undergoing maintenance hemodialysis were enrolled in this cross-sectional study.The patients were divided into two groups according to the percentage of IBWG(PIBWG:interdialytic body weight gain/dry weight×100%):PIBWG＞3.50%(190 cases)and PIBWG≤3.50%(79 cases).Associated factors of IBWG were analyzed. Results The average IBWG of 269 MHD patients was(2.42±1.01)kg(0-6.33 kg),and PIBWG was(4.25±1.79)%.In male patients,IBWG was (2.45±1.09)kg,and PIBWG was(3.99±1.79)%.In female patients,IBWG was(2.39±0.85)kg,and PIBWG was(4.64±1.74)%which was significantly higher compared to males(P＜0.01).Patients with PIBWG＜3.00%accounted for 20%,with PIBWG≥3.00%to＜5.00%accounted for 50%,with PIBWG≥5.00%accounted for 30%.Compared to patients with PIBWG＞3.50%,those with PIBWG≤3.50%were characterized by elder age(year)(60.50 ±14.49 vs 54.07±13.78),more males(70.88%vs 54.74%),shorter dialysis duration(month)(41.03±41.92 vs 58.83±43.57),larger BMI(kg/m2)(22.67±3.36 vs 20.91±3.25)and less dry weight(kg)(56.69±10.94 vs 62.82±10.97),more residual urine(ml,In)(6.19±0.94 vs 5.48±0.8),lower predialysis serum β2MG(mmol/L)(31.61±9.82 vs 38.54±10.38)and phosphorus(mmol/L)(1.92±0.66 vs 2.15±0.58).Correlation analysis revealed that PIBWG was positively correlated with dialysis duration,Scr,BUN,β2-MG,phosphorus,decrease and decrease percentage of BP during hemodialysis,and negatively correlated with age,dry weight,BMI,residual urine,and pre-dialysis SBP,MAP. Conclusions PIBWG of about 70%of our patients was below 5%.Young.female.low BMI and dry body weight,long dialysis duration,low residual urine,chronic glomerulonephritis and diabetic nephropathy are associated with more IBWG,which may lead to greater intradialytic BP fluctuation.