Objective:To compare the therapeutic effects by different longitude margins of the gross tumor volume (GTV) based on elec-tive nodal irradiation (ENI) and to investigate the optimization of clinical tumor volume (CTV) in the radical chemoradiotherapy of esophageal squamous cell carcinoma (ESCC). Methods:ESCC patients treated with chemoradiotherapy for the first time in the First Af-filiated Hospital of Xiamen University from May 2009 to November 2012 were retrospectively studied. All patients were treated with ENI for radical radiotherapy, and the patients were divided into two groups:CTV1 group (with longitudinal external expansion length of less than 3 cm) and CTV2 group (with longitudinal external expansion length of more than 3 cm). The survival time and occurrence of side effects in patients were compared. Results:Among the 142 cases of patients, 82 and 61 cases were classified under CTV1 and CTV2, respectively. No significant difference in the overall survival (OS) and local recurrence-free survival (LRFS) rates was observed af-ter 1, 3, and 5 years of treatment between the two groups. The occurrence of side effects, such as bone marrow suppression, radiation pneumonitis, radiation esophagitis, and esophageal fistula, was less than 5%in both groups, and the data show that the side effect oc-currence in CTV1 was significantly lower. Conclusion:In the radical chemoradiotherapy of esophageal cancer using ENI, the OS rate of patients with a delineated CTV according to a 3 cm GTV longitudinal external expansion length is not lower than that of patients with a delineated CTV according to a GTV longitudinal external expansion length of more than 3 cm. The results provide a reference for the optimization of CTV in the radical chemoradiotherapy of ESCC.

BACKGROUND:The comfortable shoes can absorb or reduce the impact force from the ground. Is the damped system is absent in shoes to relieve the impulse,the feet will be extremely tired,even damage the human knee joint,waist,back and brain. OBJECTIVE:To measure the changes of human plantar pressure by different sole hardness through the measurement system of plantar pressure. DESIGN,TIME AND SETTING:An observation experiment was performed in the Shanghai University of Sport between December 2008 and February 2009.PARTICIPANTS:Six volunteers wearing the experimental designed shoes were recruited from Nanjing Institute of Physical Education.METHODS:Three pairs of experimental shoes weighing 103 g were measured with shore hardness tester,as 51,62 and 69 hardness values. Accordingly they were named soft shoes,medium hardness shoes and hard shoes. The subjects were asked to do a 60-minute walk test at the speed of 2 m/s on the running platform with the experimental designed shoes,and they were determined using the insole plantar pressure measurement system of German's Novel style series of Emed-pedar.MAIN OUTCOME MEASURE:The pressure,contact area and impulse in the sole of foot.RESULTS:With the increase in hardness soles,the pressure of center plantar was shown to move from the medial first metatarsal outwards by turns. Compared with barefoot walking,the trail length of the center plantar was prolonged in subjects with medium hardness shoes and hard shoes,while shortened in subjects with soft shoes. The total pressure when you walked with soft shoes and medium hardness shoes were reduced than barefoot walking,and the pressure of walking phase wearing these two types of shoes were also reduced,while total pressure and walking phase pressure with hard shoes were both increased compared with barefoot walking. The contact area was similar between soft shoes and medium hardness shoes,but the smallest in the hard shoes. Except the increase in the initial 10 minutes,the soft shoes had no change with the medium hardness shoes. The hard shoes were firstly increased but then declined. The total impulse of medium hardness shoes was the closest to bare feet,while that of soft shoes and hard shoes were increased compared with bare foot.CONCLUSION:The plantar pressure was the greatest in the hard shoes,then medium hardness shoes and last soft shoes;the contact area was the greatest in soft shoes,then medium hardness shoes and last hard shoes;the impulse was the greatest in hard shoes,then soft shoes,and last medium hardness shoes.

Objective To evaluate the effectiveness of low-dose erythromycin for the treatment of feeding intolerance in preterm infants in China.Methods In this study,random clinical trials on the treatment of feeding intolerance in preterm infants with intravenous low-dose erythromycin published were searched at Chinese Journal Full-text Database,Chongqing Weipu Database and Wanfang database by using the methods of Cochrane systematic review.At the same time the information from related journals,professional data and network were hand-searched.The publishing deadline for the literatures reviewed in this study was August 2012.Statistical analysis of clinical data was performed by using RevMan 4.2 software provided by the Cochrane Collaboration.Results A total of 9 studies were included.The results showed that compared with the group of comprehensive therapy,the group of low-dose erythromycin was superior in the following aspects with significant differences(P ＜ 0.05):the average length of hospital stay,time of parenteral nutrition,time to full feeding,the incidence rate of feeding intolerance (Z =3.44,P =0.000 6 ; Z =6.78,P ＜0.000 01 ; Z =3.96,P ＜ 0.000 1 ; Z =2.51,P =0.01).Conclusion Low-dose erythromycin therapy for feeding intolerance in preterm infants is superior to the comprehensive therapy.It provides a prospective therapeutic method for feeding intolerance in preterm infants.However,large scale,multicenter and well-designed clinical trials should be adopted to confirm the conclusions.

Objective To analyze the status of urinary and salt iodine external quality of iodine deficiency disorders (IDD) laboratories in Shaanxi Province,and to evaluate the detection ability and quality level of IDD laboratories in Shaanxi Province at all levels.Methods In 2017,external quality control assessment of laboratories for IDD at the provincial,municipal,and county levels was conducted in Shaanxi Province.There were 1 provincial,10 municipal,and 57 county-level laboratories participated in urinary iodine assessment,and 1 provincial,10 municipal,and 36 county-level laboratories for salt iodine assessment.The testing results of urinary iodine were analyzed with Z score method (qualified:｜Z｜ ≤2;basically qualified:2 ＜ ｜Z｜ ＜ 3;unqualified:｜Z｜ ≥3),salt iodine was analyzed with reference value ± uncertainty (the test results were qualified within this range;less than or exceeded was unqualified).Results One provincial,10 municipal,and 57 county-level laboratories for urinary iodine,and 1 provincial,10 municipal,and 36 county-level laboratories for salt iodine were all passed the external quality control assessment.Both the feedback rate and qualified rate of the testing results were 100.0％.Conclusion The detection ability and quality level of urinary and salt iodine in IDD laboratories in Shaanxi Province are stable and reliable,it can provide a reliable laboratory quality assurance for surveillance and control of IDD.

Objective To evaluate the testing ability for water iodine at provincial,municipal and countylevel laboratories in Shaanxi Province in 2017,and to improve their detection levels.Methods One provincial,10 municipal and 66 county laboratories for the first time took part in the evaluation of testing results of water iodine.The evaluation results were statistically evaluated using the Z score method.When ｜Z｜ ≤2,it was qualified;when 2 ＜ ｜Z｜ ＜ 3,it was basically qualified;when ｜Z｜ ≥3,it was unqualified.Results All laboratories passed the external quality control assessment.Both the feedback rate and the qualified rate were 100％ (77/77).The provincial laboratory,7 municipal laboratories,and 42 county-level laboratories all had scores of ｜ Z ｜ ＜ 1,and the test results were qualified.Conclusions The testing ability of laboratories in Shaanxi Province is maintained at a higher level.It is able to provide reliable and strong technical support for the need in sustainable elimination of iodine deficiency disorders.

As most patients of central serous retinopathy (CSC),the symptoms of acute onset will alleviate by oneself after 4-6 months.About 30％-50％ of patients with CSC experience chronic or recurrent cases.Resulting in persistent neurosensory detachments and subretinal fluid,causing significant vision loss.Mineralocorticoid receptor (MR) is a kind of nuclear hormone receptors,plays a role in theregulation of water and electrolyte balance.Excessive MR signaling is associated with many diseases.Study found that MR antagonists decreased the thickness of the retina and improved in vision,there was no serious adverse reactions during the period of treatment.Initial dose of MR antagonists was 25 mg per day,1 week later,dosage was increased to 50 mg per day,and treatment for about 3 months.There is no conclusive effective treatment and the dosage are still unknown.MR antagonists may be a safe and effective way to treat CSC,though evidence is scant.Prospective,multicenter,large-scale trials is required.

Objective:To analyze the etiology of biliary fungal infection and risk factors of case fatality.Methods:Clinical and laboratory data of 91 biliary fungal infection patients admitted in Li Huili Hospital of Ningbo Medical Center from January 2013 to June 2019 were retrospectively reviewed, including 14 patients (16.4%) with fungal infection and 77 patients (84.6%) with fungal and bacterial mixed infection. There were 79 survivors and 12 deaths, the risk factors of fatality were analyzed by binary Logistic regression analysis.Results:The fungal strain Candida albicans was detected in 61 cases, Candida glabrata in 19 cases and Candida tropicalis in 6 cases. Drug sensitivity test showed that the fungal strains were highly sensitivity to amphotericin B and 5-fluorouracil [100.0%(91/91),97.8%(89/91)]. In 77 mixed infection cases Gram-negative bacteria was the more common (34 cases,44.2%). The average age of patients was 70.7 years old. Benign diseases were found in 66 cases (72.5%) and 61(67.0%)of them were cholelithiasis. Patients with a history of repeated biliary operation were more likely to have mixed infection of biliary fungi and bacteria (χ 2= 4.56, P=0.03). The mean albumin level in the fatal group was significantly lower than that in the survival group [(28.1±5.2)g/L vs. (33.3±5.3)g/L; t=2.77, P=0.01]. The median length of hospital stay in the survival group was significantly shorter than that in the fatal group [12.0(9.0, 18.0)d vs. 29.5 (13.0, 42.7)d; Z=-2.37, P=0.02]. Multiple logistic regression analysis showed that the history of repeated biliary operation ( OR=4.46, 95% CI: 1.06—4.97) and mixed infection of fungi with bacteria ( OR=10.20, 95% CI: 1.48—70.27) were the risk factors of case fatality. Conclusion:Candida albicans is the main fungus in biliary fugal infection which is often complicated with bacterial infection. Repeated biliary operations and mixed infection of fungi with bacteria are the risk factors of death in patients with biliary infection.

Objective To explore the the characteristics of non-motor symptoms of essential tremor(ET).Methods Totally 50 ET patients and 45 age-gender-matched healthy volunteers,admitted in Department of Neurology,The Second Affiliated Hospital of Zhejiang University School of Medicine from May 2015 to April 2016,were included.Clinical data and tremor analyses under different postures were obtained.The non-motor symptoms were evaluated using the Pittsburgh Sleep Quality Index(PSQI),Hamilton anxiety scale(HAMA),Hamilton's Depression Scale(HAMD),and the MOS item short from health survey (SF-36).Cognitive functions were evaluated by the Minimental state examination(MMSE).Results ET group had lower MMSE total score of (25.81 ±2.75 vs.28.16 ± 1.71),increased rate of dyssomnia (62.0％ vs.15.6％) and higher PQSI score (6.42±2.71 vs.3.84±2.13)compared with the control group(all P＜0.05).Moreover,more patients in the ET group had moderate and severe anxiety(60.0 ％ vs.37.8 ％),moderate and severe depression (34.0％ vs.15.6％)than the control group(both P ＜ 0.05).Anxiety and depression had effects on physical and mental health and were also related to the quality of life.Conclusions Non-motor symptoms,such as mild cognitive deficits,depression,anxiety and dyssomnia are common in ET patients.Furthermore,depression and anxiety have negative effects on physical and mental health.

Objective: To analyze the operation situation of urinary iodine, salt iodine and water iodine external quality assessment network of iodine deficiency disorders(IDD) laboratories in Shaanxi Province in 2018, and to ensure the need for IDD surveillance in Shaanxi Province at all levels. Methods: In 2018, the provincial, municipal, and county-level IDD laboratories in Shaanxi Province were evaluated for urinary iodine, salt iodine and water iodine external quality control. Among them, 1 provincial, 10 municipal, and 107 county-level laboratories took part in the testing of urinary iodine assessment; 1 provincial, 10 municipal and 39 county-level laboratories took part in the testing of salt iodine assessment; and 1 provincial, 10 municipal and 83 county-level laboratories took part in the testing of water iodine. The testing results of urinary iodine were statistically analyzed with the │Z│ score method (qualified: │Z│≤2; basically qualified: 2 <│Z│ < 3; unqualified:│Z│≥3), salt iodine and water iodine were analyzed with reference value ± uncertainty (the test results were qualified within this range; less than or exceeded was unqualified). Results: The │Z│ scores of 1 provincial, 10 municipal and 107 county-level laboratories for urinary iodine were < 3; the test results of 1 provincial, 10 municipal and 39 county-level laboratories for salt iodine, and 1 provincial, 10 municipal and 83 county-level laboratories for water iodine were qualified within reference value ± uncertainty range. All the IDD laboratories were passed the external quality control assessment of 2018. Both the feedback rate and qualified rate of the testing results were 100.00%, Conclusion The testing ability of all the laboratories are stable and reliable, it can provide a reliable laboratory quality assurance for surveillance and control of IDD.

OBJECTIVETo investigate the effect of occupational exposure to toluene diisocyanate (TDI) on the workers' health.

METHODSA total of 76 workers exposed to TDI (exposure group) and 64 management staff members (control group) were selected from a factory as the study subjects. Area sampling was performed for the place with exposure to TDI according to the method in GBZ 159-2004 Specifications of air sampling for hazardous substances monitoring in the workplace, and gas chromatography was applied to measure the concentration of TDI in workplace air. The workers' personal information was collected with questionnaire, pulmonary ventilation function was determined with a portable spirometer, hematological parameters were analyzed by automatic blood analyzer and blood chemistry analyzer, and the indicators of oxidative damage and energy metabolism were measured by the reagent kit provided by Nanjing Jiancheng Bioengineering Institute. SPSS 17 software was applied for statistical analysis.

RESULTSThe exposure group had significantly lower forced vital capacity (FVC), forced expiratory volume in 1 second(FEV1.0), and FEV1.0/FVC ratio than the control group (P <0.05). Compared with the control group, the exposure group had significantly higher red blood cell count, platelet distribution width, mean platelet volume, lymphocyte count, and neutrophil count(P<0.01), and significantly lower activities of lactate dehydrogenase(LDH), superoxide dismutase, and succinodehydrogenase (SDH)(P <0.01). In the exposure group, the length of exposure was negatively correlated with the activities of SDH and LDH in the serum (r=-0.319, P <0.05; r=-0.239, P <0.05), and the length of exposure was not found to be correlated with the activity of SOD and pulmonary function indices.

CONCLUSIONTDI can induce inflammatory response and lung ventilation function impairment in workers exposed to TDI, as well as oxidative stress and imbalance of energy metabolism. Therefore, it can cause damage to workers' health, and protective measures should be enhanced.

Case-Control Studies ; Erythrocyte Count ; Forced Expiratory Volume ; Humans ; Inflammation ; physiopathology ; L-Lactate Dehydrogenase ; blood ; metabolism ; Leukocyte Count ; Lung ; physiopathology ; Occupational Exposure ; adverse effects ; Pulmonary Ventilation ; Succinate Dehydrogenase ; blood ; metabolism ; Superoxide Dismutase ; metabolism ; Toluene 2,4-Diisocyanate ; adverse effects ; Vital Capacity