Objective To perform a systematic review and Meta-analysis on volumetric and dosimetric changes in target volumes and organs at risk (OARs) in adaptive radiotherapy (ART) for patients with head and neck cancer (HNC),and to investigate the role of ART in the treatment of HNC.Methods Literature retrieval was performed to include related studies,and the parameters of primary tumor,GTV-T and GTV-N,parotid volume,D95 and Dmean of target volumes,Dmean of ipsilateral and contralateral parotid volume (I-PG and C-PG),and Dmax of the spinal cord and brainstem.Results A total of 17 studies involving 336 patients were included in the meta-analysis.Primary tumor and parotid volume changed significantly.The volumes of GTV-T,GTV-N,and I-PG were significantly reduced during the 15-20th radiotherapy and after the 20th radiotherapy (P＜0.05),and the C-PG was significantly reduced after the 20th radiotherapy (P=0.004).The analysis of actual dose showed that the D95 and Dmean of primary tumor showed no significant differences,and during the 15-20th radiotherapy,the Dmax of the spinal cord was increased by 2.26 Gy (P=0.000),while the Dmax of the brainstem showed no significant changes before the 20th radiotherapy and was increased by 1.78 Gy after the 25th radiotherapy (P=0.020).In addition,the Dmean of I-PG was increased by 2 Gy during the 20-25th radiotherapy (P =0.0001),and the D of C-PG was increased before the 20th radiotherapy and showed no significant changes after the 25thradiotherapy (P=0.110).The dosimetric analysis of ART showed that the Dmax of the spinal cord and brainstem was reduced significantly (spinal cord:MD =-2.15,95％ CI-3.12 to-1.18,P=0.000;brainstem:MD =-2.20,95％ CI-3.32 to-1.09,P=0.000).The Dmean of I-PG was reduced by about 3.5 Gy,and the sensitivity analysis revealed that the results of Dmean of C-PG were unstable.Conclusions The volumes of primary tumors and parotid glands change significantly,and the actual doses of OARs (Dmax of the spinal cord and brainstem and Dmean of the parotid glands) significantly increase,while the doses of GTV-T and GTV-N show no significant changes.ART can effectively protect the OARs,and patients with locally advanced HNC who receive concurrent chemoradiotherapy can obtain good dose gains from ART plan performed during the 15-20th radiotherapy and at about the 25th radiotherapy.

Objective To compare the effects of positioning robustness on dose distribution between intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for head and neck tumor,and to evaluate their needs for image-based guidance.Methods Thirty patients with nasopharyngeal carcinoma undergoing IMRT were enrolled as subjects.The VMAT plans were designed according to the clinical dosimetric requirements and the dose calculation was made by the AAA method.For the two plans in each patient,the isocenters were shifted by ±1.0,±3.0,and ±5.0 mm along the original x,y,and z axes to simulate the impacts of positioning errors in left-right (LR),superior-inferior (SI),and anterior-posterior (AP) directions,respectively,on dose distribution.The dose-volume histogram parameters were analyzed in 60 references and 1080 re-calculated plans.Comparison was made by paired t-test.Results When the error was 1 mm,the average deviations of gross tumor volume (GTV) D98,clinical target volume (CTV) D95 and heterogeneity index,and planning gross tumor volume (PGTV) V95 were＜0.5％.When the error was 3 mm,the average dose deviations of GTV and CTV were＜1.0％ and significantly larger in VMAT than in IMRT;the average dose deviation of PGTV was large (GTV D98,P=0.00;CTV D95,P=0.00);the average deviations of PGTVnxV95 and PGTVndV95 were significantly smaller in IMRT than in VMAT (1.64％vs.1.95％,P=0.01;1.73％ vs.2.63％,P=0.00).The deviations of parameters became larger with the increasing positioning error and were significantly larger in VMAT than in IMRT (GTV D98,P=0.00;CTV D95,P=0.00;CTV HI;P=0.00;PGTV V95;P=0.01).Compared with the target volume,Dmax to the spinal cord and brain stem had larger deviations.However,there were no significant differences in Dmax to the spinal cord and brain stem between IMRT and VMAT.Conclusions The IMRT and VMAT plans are both robust when the positioning error is small (＜3 mm).Compared with IMRT,VAMT is more sensitive to the positioning error,mainly in the target volume.The difference between the two plans becomes larger with the increasing positioning error.An increase in the frequency of image-based guidance is recommended for patients undergoing VMAT.

Objective:To evaluate the effects of ulinastatin on inflammatory response and liver and kidney functions after chest operation.Methods:Forty patients who received chest operation were randomly divided into two groups as test group(20) and control group(20).For the test group,we use 300 000 unit ulinastatin respectively 1 day before and 1,2,3 days after the operation.For the control group,we use the physiological saline at the same time.We detected IL-6,IL-8,FN and TNF-? levels and functions of several viscera by measuring aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TB),Scr,BUN,Cr pre-operation and 1 d,3 d,5 d and 7 d post-operation.Results: In the operation group,the levels of IL-6, IL-8 and TNF-? were lower than those of patients in the control group at 1 d,3 d,5 d,and 7 d after operation.The levels of ALT,AST,and TB of patients in the test group were lower than those of patients in the control group at 1 d, 3 d,and 5 d after operation.The liver and kidney function recovered to normal in the test group 7 d post operation.Conclusion: Ulinastatin has protective effect during the recovery of patient's liver and kidney functions after chest surgery.The results confirmed that ulinastatin can enhance the body's tolerance to surgery stress by suppressing the secretion of harmful cytokines.

Objective To study the epidemiological features of patients for emergency transport so as to enhance the control level of pre hospital emergency treatment. Methods Investigations were made of 956 cases of patients for emergency transport in the authors hospital in 2000～2001 and their epidemiological features analyzed. Results Among the 956 cases, males outnumbered females, patients within the age group of 20 to 39 numbered 391, accounting for 40.9%, and patients within the age group of 50 to 69 numbered 400, accounting for 41.8%. Of all the cases, ordinary ones numbered 671(70.2%),critical ones numbered 241(25.2%), and cases that died numbered 44(4.6%). The first three diseases demanding emergency transport were successively craniocerebral wound(17.4%), cerebrovascular disease(16.0%), and cardiovascular disease(13.5%). The periods for emergency transport ranged mainly from 9:00 to 12:00 and from 15:00 to 18:00. The sources of emergency cases were successively township hospitals(53.8%), hospitals at the county level(26.0%), and hospitals at the city level(20.2%). Conclusion Control of pre hospital emergency treatment needs to be strengthened according to the epidemiological features of patients for emergency transport.

Objective: To characterize the “multi-components, multi-targets, and multi-pathways” mechanism of Jiangzhi Ligan Decoction on non-alcoholic fatty liver disease (NAFLD) using network pharmacology technology. Methods: Data regarding natural molecules of Jiangzhi Ligan Decoction, targets of NAFLD, and interactions between natural molecules and NAFLD targets were screened. Network pharmacology of the interactions between natural molecules and NAFLD targets were established using Cytoscape software. The biological process and the signaling pathway of the putative targets were analyzed using ClueGO. Results: The network analysis indicated that 82 active ingredients and 53 NAFLD related targets were screened in Jiangzhi Ligan Decoction, which was involved in regulation of insulin resistance, oxidative stress, inflammation, PI3K/Akt signaling pathway, inflammasome signaling pathway, IL-10 signaling pathway, and T cell signaling pathway. Conclusion: This study provides an important basis for further study on the pharmacological mechanism of Jiangzhi Ligan Decoction in the treatment of non-alcoholic fatty liver disease.

Objective: To observe the effects of electroacupuncture (EA) on uterine prostaglandin F2α (PGF2α), cyclooxygenase 2 (COX-2) and nuclear factor κB (NF-κB) in rats with primary dysmenorrhea (PD) and to discuss the possible mechanism in EA intervening PD. Methods: Forty Sprague-Dawley female rats were randomly divided into a blank group, a model group, an EA group and an ibuprofen group, with 10 rats in each group. The PD model was established using estradiol benzoate combined with oxytocin in the model group, EA group and ibuprofen group. At the same time of modeling, rats in the EA group were given EA at Guanyuan (CV 4) and Sanyinjiao (SP 6) once a day for 20 min each time for 10 consecutive days. Ibuprofen was intragastrically administered once a day for 10 consecutive days in the ibuprofen group. The same amount of normal saline was intragastrically administered once a day for 10 consecutive days in the blank group and model group. The number of writhing of rats in each group within 30 min was compared on the 11th day just after the interventions. The uterine homogenate supernatant was separated and the PGF2α level was detected by enzyme-linked immunosorbent assay. Western blot was applied for the detection of the expression levels of COX-2, phospho-NF-κB p65 and NF-κB p65 proteins in uterine tissues. Results: Compared with the blank group, the number of writhing in the model group increased significantly (P<0.01), and the expression levels of PGF2α, COX-2, phospho-NF-κB p65 and NF-κB p65 proteins in uterine tissues were significantly increased (all P<0.01). Compared with the model group, the number of writhing in the EA group and ibuprofen group were significantly reduced (both P<0.01), and the expression levels of PGF2α and COX-2 protein in uterine tissues were significantly reduced (both P<0.01). Compared with the model group, the phospho-NF-κB p65 level in uterine tissues in the EA group was significantly reduced (P<0.01). Compared with the ibuprofen group, the phospho-NF-κB p65 level in the EA group was significantly reduced (P<0.01). Conclusion: The mechanism of EA for PD rats may be related to inhibiting the phosphorylation of NF-κB and reducing the levels of COX-2 and PGF2α in uterine tissues.

Objective To evaluate the clinical application of computer-aided electromagnetic imaging navigation in nasal endoscopic surgery.Methods Twenty-two cases of nasal endoscopic surgery with intraoperative imaging navigation were retrospectively reviewed,including 16 cases of sinusitis with or without polyp;5 cases of nasal inverting papilloma; 1 case of maxillary capillary hemangioma.All cases were operated with computer-aided electromagentic imaging navigation and nasal endoscope.Results The preoperative preparing time would take 4-10 minutes.In 22 cases,the localization accuracy between 3-D image landmarks of navigation system and actual anatomical landmarks was less than 1 mm.The optic nerve and other anatomical landmarks could be orientated accurately in intraoperative procedures.No complication occurred.Conclusions Nasal endoscope combined with computer-aided electromagnetic imaging navigation provides accurate anatomical localization of nasal cavity,sinuses and anterior skull base.It could improve the effectiveness and decrease surgical complications,especially in complicated cases.

Objective:On the basis of synthetic antigens on minoxidil ,we prepared its polyclonal antibody and established a ELISA method to detect minoxidil .Methods:We synthesized minoxidil artificial antigen with glutaraldehyde and identified by UV scan -ning.We had established a detection of minoxidil competition ELISA .Results: The UV scan showed that the minoxidil successfully coupled to a carrier protein.The conjugate of minoxidil-BSA was used to immunize BALB/c mice.And the produced antiserum showed high titer of 1:12 800 in the indirect ELISA.Its ELISA curve equation:y=-0.082 3 x+0.938 ( R2 =0.9811 ) , minoxidil mass concentration and the absorbance in 0.001-10 μg/ml showed a good linearity .Conclusion: This method has been successfully preparing minoxidil artificial antigen and polyclonal antibodies and established ELISA detection method for minoxidil ,which provides a basis for the practical application of minoxidil immunoassay method .

Objective To investigate the effect and safety of primary percutaneous coronary intervention (PCI) of acute ST-segment elevation myocardial infarction (STEMI) in elderly patients.Methods 103 consecutive patients with STEMI treated by primary PCI were divided into two groups according to the age:the elderly group [aged≥65 years,with a mean age of (75.7 ±6.2) years(n =49],the non-elderly group [aged＜65 years,with a mean age of (43.0±8.6) years(n =54].Clinical characteristics,complications related to PCI procedure and success rate were analyzed,and major cardiovascular events (MACE) were followed up for(5.7 ± 1.2) months.Results The proportion of female,patients with Killip ≥ Ⅲ,three vessels disease and higher level of serum brain natriuretic peptide were higher in elderly group than in non-elderly group (all P＜0.05).No significant difference was observed between the two groups in success rate and complications of PCI procedure (both P＞0.05).Patients were followed up for (5.7± 1.2) months.The in-hospital and one-month mortalities were higher in elderly group than in non-elderly group [8.2％ (4 cases)vs.0％ (0 case),10.2％(5 cases) vs.0 ％ (0 case),respectively,all P＜0.05].There was no significant difference in six-month mortality and MACE between the two groups.Multivariate logistic regression analysis showed that Killip ≥ Ⅲ was related with the increase of one-month mortality in patients with STEMI undergoing primary PCI,whereas age was not.Conclusions Primary PCI is effective and safe in elderly patients with STEMI.

0.05).AA-I could induce the TGF-?1 secretion by HK-2 cells(18.26?5.98 ?g/L,vs.control,P