This paper introduces the technical parameters,basic principle and investigation method of the multiparameter supervisor.The functions and implementation methods of its components are also presented.The supervisor can provide much physiological information of the patients to medical staffs.Thus,the level of medical supervision and analysis can be enhanced.The multiparameter supervision can be realized when the microcomputer system with PC-104construction is adopted to analyze the received signals and filter the interfering signals resulting from the random variations of frequency and amplitude.

Objective To investigate the detection rate of malnutrition among post-stroke patients in community hospitals and unravel the relevant factors that precipitate malnutrition after stroke. Methods Based on 438 post-stroke patients who were admitted in community hospitals, we examined the demographic characteristics, the nutritional indices and the possible malnutrition related factors through a cross-sectional study.Results The detection rate of malnutrition among post-stroke patients was 52.7%. Group comparison through multivariate logistic regression analysis showed that there was a higher malnutrition detection rate in the post-stroke patients with multiple stroke attacks (three stroke attackes and above, OR = 11.00,95%CI 1. 14-106.34), higher NIHSS scores (group with NIHSS≥15, OR=7.09, 95% CI 2.90-17.36) , higher modified Rankin scales (group mRS 4-5, OR = 15. 77,95% CI 6.61-37.59) (trend test P<0.0001) .The risk of malnutrition was also correlated with the post-stroke depression, poorer family care, no early-stage rehabilitation, history of malignant tumors and severe alcoholism. Conclusions There is a high detection rate of malnutrition among post-stroke patients in community hospitals. There are many factors related to malnutrition among post-stroke patients in the community. More attention to controllable influencing factors would improve the prognosis of post-stroke patients.

Objective By analyzing the urinary calculi ingredient and 24-hour urinary stone risk factors of urolithiasis patients in Hengyang area,to investigate the effects of diet intervention on recurrence rate in urolithiasis patients,and provide the measures for prevention and treatment.Methods Prospectively collected 692 patients that permanent residents in Hengyang area from September 2008 to September 2012,who had implementation of minimally invasive operation and taken stone specimens to analyze composition,and also collected 24 hours urine to analyze the urinary stone risk factors.They were divided into test group and control group by random number table method,346 cases in each,control group without diet intervention,and test group was given diet intervention according to the stone composition and urinary stonerisk factors.All patients were followed up for 1 year,the urinary stone recurrence rate in Hengyang area was observed.Results Among 692 urolithiasis patients,663 patients completed the study (test group of 341 cases and control group of 322 cases),the expulsion rate was 4.19％(29/692).The 24-hour urinary stone risk factors in control group before and after diet intervention had no significant difference(P ＞ 0.05).In test group after diet intervention,the excretion of ingredients in urine such as dietary calcium (t =3.412,P ＜ 0.05),oxalate(t =3.018,P ＜ 0.05) and uric acid(t =1.990,P ＜ 0.05) was obviously decreased,and urinary citrate (t =3.174,P ＜ 0.05) was increased,but the excretion of ingredients such as magnesium and phosphorus had no significant difference (P ＞ 0.05).After 1 year after diet intervention,the recurrence rate in test group was lower than that in control group [0.88％ (3/341) vs.7.76％ (25/322)],there was significant difference (P ＜ 0.01).Conclusion Diet intervention can effectively reduce the risk of urinary stone according to the stone composition and the 24 hours urine stone risk factors,plays an important role on reducing urinary stone recurrence,which is worth clinical promotion.

Objective To investigate the interfractional and intrafractional prostate motion during hypofractionated precise radiotherapy for prostate cancer. Methods From 2013 to 2016, twenty?eight patients who received 5 Gy radiotherapy in 9 fractions for prostate cancer were enrolled as subjects. Every patient had three gold fiducials implanted into the prostate by transrectal ultrasound guidance two weeks before computed tomography ( CT) simulation. All patients underwent CT scans in the supine position with full bladders and rectal balloons filled with 60 ml air. The Pinnacle planning system was used to design the treatment plans. Twenty?three patients were treated with a Synergy accelerator. Those patients underwent cone?beam CT ( CBCT) scans prior to treatment. The set?up error was recorded by bone alignment between CBCT images and planning CT images. The prostate displacement was then recorded by gold fiducial alignment. The interfraction prostate displacement was defined by the difference between the above two parameters. The other 5 patients were treated with a Novalis accelerator. Based on gold fiducial alignment,the real?time tracking of gold fiducials was carried out by the ExacTrac system to evaluate the intrafractional prostate displacement. Results A total of 207 measurements of interfractional prostate displacement were made in the 23 patients before treatment. The mean interfractional prostate displacements in the left?right (LR),superior?inferior (SI),and anterior?posterior (AP) directions were (0.05±0?10),(0.20±0?22),and (0.19±0?18) cm,respectively. The displacements larger than 0?3 cm in the above three directions were observed in 1,52,and 49 measurements,respectively,while the displacements larger than 0?5 cm in the three directions were observed in 1,29,and 16 measurements,respectively. A total of 225 measurements of gold fiducial displacement were made in the 5 patients during treatment. The mean intrafractional prostate displacements in LR,SI,and AP directions were (0.61±0?50),(0.68±0?69),and (0.70±0?67) mm, respectively. The displacements larger than 3 mm in the three directions were observed in 0, 1, and 1 measurement, respectively. Conclusions In hypofractionated precise radiotherapy for prostate cancer, the interfractional prostate displacement is significantly larger than the intrafractional prostate displacement. The interfractional prostate displacement must be corrected before radiotherapy. In order to avoid off?target irradiation due to postural changes in patients,the tracking of the intrafractional prostate displacement is still necessary although the displacement is relatively small. The rectal balloon can help immobilize the prostate.

Objective To retrospectively analyze the efficacy of pelvic radiotherapy and prognostic actors for stage IV rectal cancer. Methods From 2000 to 2010, 61 patients with stage IV rectal cancer who eceived pelvic radiotherapy with or without rectal surgery were enrolled as subjects. In those patients, 19 ad both primary and metastatic tumors resected, 19 had only primary tumor resected, and 23 received elvic radiotherapy with both primary and metastatic tumors intact. The Kaplan?Meier method was used to stimate survival rates, and the log?rank test was used for survival difference analysis and univariate rognostic analysis. Comparison of disaggregated data was made by Fisher′s exact test. Results The 5?year verall survival ( OS ) and progression?free survival ( PFS ) rates in all patients were 26% and 17%, espectively. The prognostic analysis showed that stage T4 , positive node, age greater than 65 years, metastasis outside the liver, and intact primary tumor were prognostic factors for OS, while stage T4 , positive ode, and intact primary tumor were prognostic factors for PFS. In patients with both primary and metastatic umors resected, 5?year OS rates in patients treated with and without pelvic radiotherapy were 67% and 2%, respectively (P=0?119). In patients with intact metastatic tumor, 2?year OS rates in patients with esected and intact primary tumor were 52% and 27%, respectively ( P=0?057 ) . Only 4 patients who eceived pelvic radiotherapy alone for primary rectal tumor needed ostomy. Conclusions The value of ostoperative pelvic radiotherapy still needs further studies in patients with stage IV rectal cancer and esectable metastatic tumor. Pelvic radiotherapy for primary tumor achieves definitive treatment outcomes in atients with stage IV rectal cancer and unresectable primary and metastatic tumors.

Objective:To observe the efficacy of trigeminal nerve microvascular decompression in the treatment of elderly trigeminal neuralgia.Methods:A total of 96 elderly patients with trigeminal neuralgia admitted to our hospital from January 2015 to June 2016 were selected.48 patients were treated with percutaneous trigeminal semilunar ganglion radiofrequency thermocoagulation as a control group, and the other 48 patients were treated with trigeminal nerve microvascular decompression as the observation group.Efficacy indicators of post-operative pain severity scores, severity scores of post-operative complications, a sum of two categories of severity scores, which were compared between the two groups at one month and at 1, 3, 5 years after surgery.Results:One month after the operation, there was no significant differences in pain severity score, surgical complications severity scores, and a sum of two categories severity scores between the two groups of patients(all P>0.05). In the observation group versus the control group, pain severity scores were[(0.55±0.39)scores versus(0.94±0.61)scores, t=7.572, P=0.011 at 1 year after operation], [(0.81±0.61)versus(1.19±0.83)scores, t=7.513, P=0.012 at 3 years after operation]and[(1.13±0.65)and(1.55±0.91)scores, t=7.837, P=0.010 at 5 years after operation]respectively, showing more efficacy in observation group.In the observation group versus the control group, severity scores of surgical complications were[(0.39±0.28)and(0.67±0.49)scores, t=7.290, P=0.014, at 1 year after operation], [(0.65±0.37)and(0.94±0.55)scores, t=7.353, P=0.013 at 3 years after operation]and[(0.80±0.35)and(1.13±0.64)scores, t=7.475, P=0.012 at 5 years after operation], respectively, showing more efficacy in observation group.In the observation group versus the control group, overall efficacy from a sum of the two categories of severity scores were[(0.72±0.35)and(1.33±0.56)scorets, t=7.701, P=0.009 at 1 year after operation], [(1.21±0.49)and(1.78±0.70)scores, t=7.580, P=0.011 at 3 years after operation]and[(1.46±0.55)and(2.24±1.03)scores, t=8.026, P=0.007 at 5 years after operation], respectively, showing more efficacy in observation group.Overall, above three severity scores were lower than in the observation group than in the control group(all P<0.05). Conclusions:For elderly patients with trigeminal neuralgia, trigeminal nerve microvascular decompression has definite efficacy, long duration of pain relief, low incidence of surgical complications, and is safe and reliable, which is worthy of clinical application.

Objective:To compare magnetic resonance imaging (MRI)-based and computed tomography (CT)-based target volume delineation and dose coverage in partial breast irradiation (PBI) for patients with breast cancer, aiming to explore the application value of MRI localization in PBI after breast-conserving surgery.Methods:Twenty-nine patients with early breast cancer underwent simulating CT and MRI scans in a supine position. The cavity visualization score (CVS) of tumor bed (TB) was evaluated. The TB, clinical target volume (CTV), planning target volume (PTV) were delineated on CT and MRI images, and then statistically compared. Conformity indices (CI) between CT- and MRI-defined target volumes were calculated. PBI treatment plan of 40 Gy in 10 fractions was designed based on PTV-CT, and the dose coverage for PTV-MRI was evaluated.Results:The CVS on CT and MRI images was 2.97±1.40 vs. 3.10±1.40( P=0.408). The volumes of TB, CTV, PTV on MRI were significantly larger than those on CT, (24.48±16.60) cm 3vs. (38.00±19.77) cm 3, (126.76±56.81) cm 3vs. (168.42±70.54) cm 3, (216.63±81.99) cm 3vs. (279.24±101.55) cm 3, respectively, whereas the increasing percentage of CTV and PTV were significantly smaller than those of TB. The CI between CT-based and MRI-based TB, CTV, PTV were 0.43±0.13, 0.66±0.11, 0.70±0.09( P<0.001), respectively. The median percentage of PTV-MRI receiving 40 Gy dose was 81.9%(62.3% to 92.4%), significantly lower than 95.6%(95.0%~97.5%) of PTV-CT. Conclusions:The CVS between CT and MRI is not significantly different, but the MRI-based TB, CTV, PTV are significantly larger than CT-based values. The PTV-MRI is of underdose if PBI treatment plan is designed for PTV-CT. As a supplement of CT scan, MRI can enhance the accuracy of TB delineation after breast-onserving surgery.

Objective: To analyze the failure patterns of locoregional recurrence (LRR) and investigate the range of radiotherapy in T_1-2N₁ breast cancer patients undergoing modified radical mastectomy. Methods: From September 1997 to April 2015, 2472 women with T_1-2N₁ breast cancer after modified radical mastectomy without neoadjuvant systemic therapy were treated in our hospital. 1898 patients who did not undergo adjuvant radiotherapy were included in this study. The distribution of accumulated LRR was analyzed. The LR and RR rates were estimated by the Kaplan-Meier method, and the prognostic factors were identified in univariate analyses with Log-rank test. Multivariate analysis was performed using Cox logistic regression analysis. Results: With a median follow-up of 71.3 months (range 1.1-194.6), 164 patients had LRR, including supraclavicular/infraclavicular lymph nodes in 106(65%), chest wall in 69(42%), axilla in 39(24%) and internal mammary lymph nodes (IMNs) in 19 patients (12%). In multivariate analysis, age (>45 years vs.≤45 years), tumor location (other quadrants vs. inner quadrant), T stage (T₁ vs. T₂), the number of positive axillary lymph nodes (1 vs. 2-3), hormone receptor status (positive vs. negative) were significant prognostic factors for both LR and RR. Conclusions In patients with T_1-2N₁ breast cancer after modified radical mastectomy, the most common LRR site is supraclavicular/infraclavicular nodal region, followed by chest wall. The axillary or IMN recurrence is rare. The prognostic factors for LR and RR are similar, which indicates that supraclavicular/infraclavicular and chest wall irradiation should be considered for postmastectomy radiotherapy.

Objective:To investigate the radiation field and dose selection of patients with isolated chest wall recurrence (ICWR) after modified radical mastectomy, and analyze the prognostic factors related to subsequent chest wall recurrence.Methods:Clinical data of 201 patients with ICWR after mastectomy admitted to the Fifth Medical Center, Chinese PLA General Hospital from 1998 to 2018 were retrospectively analyzed. None of the patients received postoperative adjuvant radiotherapy. After ICWR, 48 patients (73.6%) underwent surgery and 155 patients (77.1%) received radiotherapy. Kaplan-Meier method was used to calculate the post-recurrence progression-free survival (PFS) rates and the difference was compared by log-rank test. Multivariate analysis was performed using Cox regression model. Competing risk model was adopted to estimate the subsequent local recurrence (sLR) rates after ICWR and the difference was compared with Gray test. Multivariate analysis was conducted using F&G analysis. Results:With a median follow up of 92.8 months after ICWR, the 5-year PFS rate was 23.2%, and the 5-year sLR rate was 35.7%. Multivariate analysis showed that patients with surgery plus radiotherapy and recurrence interval o F>12 months had a lower sLR rate. Patients with recurrence interval o F>48 months, local plus systemic treatment and surgery plus radiotherapy had a higher PFS rate. Among the 155 patients who received chest wall radiotherapy after ICWR, total chest wall irradiation plus local boost could improve the 5-year PFS rate compared with total chest wall irradiation alone (34.0% vs. 15.4%, P=0.004). Chest wall radiation dose (≤60 Gy vs.>60 Gy) exerted no significant effect upon the sLR and PFS rates (both P>0.05). In the 53 patients without surgery, the 5-year PFS rates were 9.1% and 20.5%( P=0.061) with tumor bed dose ≤60 Gy and>60 Gy, respectively. Conclusions:Local radiotherapy is recommended for patients with ICWR after modified radical mastectomy of breast cancer, including total chest wall radiation plus local boost. The radiation dose for recurrence should be increased to 60 Gy, and it should be above 60 Gy for those who have not undergone surgical resection. In addition, patients with ICWR still have a high risk of sLR, and more effective treatments need to be explored.

Objective: To validate whether the prognostic stage groups by the 8th edition of the American Joint Committee on Cancer (AJCC) staging system provides improved prognostic accuracy in T1-2N1M0 postmastectomy breast cancer patients compared to 7th edition. Methods: a total of 1 823 female patients with T1-2N1M0 breast cancer who underwent mastectomy and axillary lymph node dissection without neoadjuvant chemotherapy were analyzed and restaged according to 8th edition. Univariate analysis of prognostic factors was evaluated by using log-rank test. Multivariate analysis was estimated by using the Cox proportional hazards model. The prognostic accuracy of the two staging systems was compared using receiver operating characteristic (ROC) analyses and the concordance index (C-index). Results: 5-year locoregional recurrence rate (LRR) for the whole group was 6.0%, 5-year distant metastasis (DM) rate was 11.5%, 5-year disease-free survival (DFS) was 85.0%, and 5-year overall survival (OS) was 93.1%. Cox analysis showed that 7th edition of the AJCC staging system and progesterone receptor status were independent risk factors for LRR, DM, DFS and OS (P<0.05). Compared with stage by 7th edition, 1 278(70.1%) were assigned to a different prognostic stage group: 1 088 (85.1%) to a lower stage and 190 (14.9%) to a higher stage. LRR, DM, DFS and OS were significantly different between prognostic stage ⅠA, ⅠB, ⅡA, ⅡB and ⅢA according to 8th edition of the AJCC staging system(P<0.001). Prognostic stage had significantly higher C-indexes and provided better estimation of prognosis compared to stage by 7th edition of the AJCC staging system (P<0.001). Conclusion The prognostic stage groups of 8th edition AJCC staging system has superior prognostic accuracy compared to 7th edition in T1-2N1M0 breast cancer, and has better clinical therapeutic guidance value.