Objective To evaluate the clinical aesthetic effect of immediate implant and immediate prosthesis by the free connec-tive tissue transplantation with periosteum in the maxillary anterior region.Methods 65 appropriate patients were selected and per-formed the immediate implant after minimally invasive tooth extraction.6 5 pieces of implants were implanted immediately by the free connective tissue transplantation with periosteum in the aesthetic area,among them,10 cases were implanted by Bio-oss bone. All missing teeth were immediately repaired by temporary denture,after the implant osseointegration,the permanent repair was per-formed.From the preoperation to 1 8 months after permanent repair,the aesthetic evaluation was conducted by stages,including the labial peri-implant soft tissue fullness and pink aesthetic scores(PES).Results In the tracing assessment period,the peri-implant fullness evaluation showed that degree 0 was found in 5 tooth positions before the operation,degree Ⅰin 60 tooth positions,degreeⅡ in 0 tooth position,but after immediate restoration,degree 0 in 0 tooth position,degree Ⅰin 45 tooth positions and degree Ⅱ in 20 positions.The PES total value reached the maximum in 3 months after permanent restoration.Conclusion Immediate implant and immediate prosthesis by the free connective tissue transplantation with periosteum in the maxillary aesthetic area can obtain better aesthetic results.

Objective:To explore influence of negative emotions on prognosis of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI) .Methods :Self‐rating anxiety scale (SAS) and self‐rating depression scale (SDS) were used to assess 90 patients undergoing PCI .According to the score results ,patients were divided into pure depression group (n=28 ,occupied 31.11% ) ,pure anxiety group (n=22 ,24.44% ) ,anxiety com‐plicated depression group (n= 25 ,27.78% ) and normal group (n = 15 ) . All patients were followed up for 12 months ,and Logistic regression analysis was used to analyze risk factors for major adverse cardiovascular events (MACE) .Results:Incidence rates of MACE in pure depression group ,pure anxiety group and anxiety complicated depression group were significantly higher than that of normal group (42.86% vs .40.91% vs .64.00% vs .6.67% , P<0.05 or <0.01) ,and that of anxiety complicated depression group was significantly higher than those of pure depression group and pure anxiety group (P<0.05 both) .Logistic regression analysis indicated that anxiety ,depres‐sion ,anxiety complicated depression were risk factors for MACE (OR = 1.49 ,2.16 ,3.28 , P < 0.05 or < 0.01) . Conclusion : Most patients undergoing coronary intervention possesses negative emotions ,which are risk factors for adverse clinical events and affect their prognosis .

The tumor hospital has its unique resources superiority.To collect and utilize the information from tumor patients,information from their diagnosis and treatment,and biological specimens,through clinical epidemiology methods and design,would facilitate the deep development in the management and research at tumor hospitals in the new circumstances.Nantong Tumor Hospital,a first rate 3A hospital,and also one of the earliest-run specialized tumor hospitals in prefecture-level cities,possesses own basis for clinical epidemiological research,medical follow-up,and application of biobanking.In this paper we report the specific work plan and work contents,including:to establish a hospital-based cancer registry system for serving clinical epidemiology; to set up a follow-up system for clinical cases with tumor,in order to assess the effect of factors on tumor treatment and to analyse their survival rates; to build a biobank of tumor cases with perfect epidemiological information and background,fitting in with the needs of the development of translational medicine.The bottleneck problems in the work are also discussed.

Objective To compare the dosimetric difference of volumetric modulated arc therapy (VMAT) plans for the loco-regionally advanced nasopharyngeal carcinoma (NPC) patients using 6 MV X-ray flattening filter-free (FFF) and flattening filter (FF) modes.Methods Ten previously treated patients with loco-regionally advanced nasopharyngeal carcinoma were retrospectively included and replanned using FFF and FF VMAT,respectively.Meeting all clinical criteria,the dose-volume histograms (DVH),dose distribution of target volume and organs at risk (OARs),target conformity index (CI),total monitor unites (MUs) and treatment time were compared across the plans.Results VMAT plans suing either FFF and FF modes can meet the clinical objectives.The maximum and mean target dose of FFF VMAT plans were significantly higher than that of FF VMAT plans (t =-0.31,-O.35,P ＜ O.05).Yet the planning target volume (PTV) CI of FF mode was slightly better than of FFF mode (t =5.42,P ＜0.05).The maximum doses of lenses in FFF VMAT plans were lower than that of FF VMAT plans (t =25.87,17.45,P ＜ 0.05),and other OARs displayed no significant difference.The mean total MUs of FFF and FF VMAT plans were (699 ± 16) and (628 ± 12) MUs respectively.The mean treatment time of two modes were consistent (about 2 min).Conclusions The plan qualities of FFF and FF VMAT plans were comparable and both clinically acceptable.The OARs at the edge of radiation field,such as lens,could be spared better using FFF VMAT mode.The total MUs of FFF VMAT plans were higher than FF VMAT plans,yet were delivered within the same time.

Objective To investigate the dose distribution and radiation risk of Varian thoracic cone beam computed tomography (CBCT) with default parameters with reference to Monte Carlo simulation and International Commission on Radiological Protection (ICRP) report 110.Methods EGSnrc/BEAMnrc code was used to simulate the material, thickness, and geometry of the kV CBCT source (kVS) to establish the kVS model.A benchmarked MCSIM code was applied to calculate the dose distribution in the ICRP phantom after the scan with the standard thoracic parameters (110 kV, 20 mA, and 262 mAs), and the conversion coefficient of absolute dose was obtained in a spherical phantom following the TG-61 protocol.The results of Monte Carlo simulation were validated by PDD and Profile in a water phantom and the measurement of the absolute dose in the computed tomography dose index (CTDI) phantom and Alderson phantom.The models including BEIR VⅡ were used to evaluate the radiation risks.Results With reference to the criterion of 3%/1 mm, the uncertainties of PDD and Profile were less than 2%.The difference between the measured and calculated values was<2.9% in the CTDI phantom and ≤0.05 cGy in the Alderson phantom.In the ICRP110 phantom, the doses to the left lung, right lung, left breast, right breast, heart, thyroid, trachea, cancellous bone, and cortical bone were 1.28, 1.39, 1.74, 1.80, 1.46, 0.48, 0.88, 0.85, and 1.84 cGy, respectively.The relative risks of ischemic heart disease, breast cancer, lung cancer, thyroid cancer, and tracheal cancer in a standard scan were1.001 , 1.009, 1.019, 1.000, and 1.008, respectively. Conclusions The accumulated dose and long-term risks of CBCT during image-guided thoracic radiotherapy cannot be neglected and should be effectively controlled.

Objective Knowledge?based radiotherapy ( KBRT ) can reduce the plan quality variability induced by different experiences between physicians and improve the quality of treatment plans. Methods The Varian Rapid Plan system was used to train a dose?volume histogram ( DVH) prediction model. The obtained model was preliminarily applied to semi?automatic design of the preoperative treatment plans for rectal cancer. Eighty high?quality volumetric modulated arc therapy plans were imported into the model training set of the Rapid Plan system. The structures of the plans were matched to the corresponding labels and codes as listed in the library. The training started after the verification of prescription. The residual plots,regression curves,geometric plots for organ at risk ( OAR) ,in?field DVH plots,and model training logs were examined. After removal of the mismatch, the original plans were assessed to rule out outliers and influential data points. More similar plans may be added for another round of training. Ten KBRT plans were designed using the final model and compared with the clinical plans. Results For the two major OARs,the femoral head and bladder,the average goodness of fit of the principal component were 0?999 415/1.0 and 0?999 963/1.0 for the DVH model,and 0?999 651/1.0 and 0?999 945/1.0 for geometry?based expected dose model,respectively. In all the plans, 11 had Cook ’ s distance values exceeding the tolerance and 4 had studentized residual values exceeding the tolerance. The outliers were all kept in the training set to generalize the scope of the model. The 10 KBRT plans had significantly improved homogeneity indices for PGTV and PTV than the original plans (P=0?00,0?04).The 10 KBRT plans also had significantly reduced D50% to the femoral head and bladder as well as significantly reduced mean doses to the bladder than the original plans (P=0?042,0?000,0?005). Conclusions In this study,the Rapid Plan system is used to train a KBRT model for design of preoperative radiotherapy plans for rectal cancer. The results of preliminary application meet the clinical requirements.

Objective To determine the levels of plasma histamine and oxidative status in patients with dermatographism before and after the treatment with anti-histamine drugs. Methods Totally, 85 patients with dermatographism were randomly divided into two groups to receive oral desloratadine and cetirizine respectively for 4 weeks. Enzyme linked immunosorbent assay (ELISA) was performed to detect the plasma level of histamine, superoxide dismutases (SOD), glutathion peroxidase (GSH-PX) and malondialdehyde (MDA) in all the patients before and after the treatment and in 15 normal human controls. The efficacy of desloratadine and cetirizine for dermatographism was estimated. Results The response rate was 83.72% and 78.57% in patients treated with desloratadine and those with cetirizine, respectively (x2 = 0.369, P> 0.05). The untreated patients with dermatographism showed an elevation in the plasma level of histamine (3.87 ± 1.21 ng/ml vs. 1.76 ± 0.56 ng/ml, P< 0.05) and MDA (3.86 ± 1.03 nmol/ml vs. 2.19 ± 0.82 nmol/ml, P< 0.05), but a decline in the activity of SOD (86.29 ± 19.9 U/ml vs. 112.12 ± 27.88 U/ml, P< 0.05) and GSH-PX (74.52 ± 47.67 vs.915.06 ± 115.96, P< 0.05) compared with the normal human controls. The treatment with antihistamine induced a reduction in the plasma level of histamine (1.61 ± 0.47 ng/ml vs. 3.87 ± 1.21 ng/ml, P< 0.05) and MDA (2.65 ± 0.77 nmol/ml vs. 3.86 ± 1.03 nmol/ml, P< 0.05), but an increment in the activity of GSH-PX (921.46 ± 157.37 vs.74.52 ± 47.67, P < 0.05) with no changes of SOD in patients with dermatographism. Conclusions In patients with dermatographism, plasma histamine is increased and there is an imbalance of oxidation-antioxidation.Desloratadine and cetirizine are effective for the treatment of dermatographism.

Objective:To solve the problems in intensity-modulated radiation therapy (IMRT) planning, such as large labor cost and high dependence on the experience of physicists and great inconsistency in the quality of plan, and to discuss an unsupervised automatic treatment planning procedure of IMRT.Methods:The eclipse scripting application programming interface (ESAPI) within the Eclipse treatment planning system (TPS) 15.6 and optimization parameters tree search algorithm (OPTSA) were used to emulate and realize the whole planning process. Interacted with the TPS through ESAPI, relevant dosimetric parameters were input and output. The OPTSA evaluated the plan qualities based on dosimetric parameters of the targets and organs at risk (OARs) and iteratively adjusted the optimization objective parameters to achieve a progressively improving IMRT plan. In order to verify the effectiveness of the automatic planning, twenty historical rectum cancer cases were selected from the clinical database, and the dose distribution and specific dosimetric parameters were compared between the plans generated by the OPTSA and the manual plans under the same constraints.Results:All the auto plans have met clinical requirements. Furthermore, 90% and 10% of the auto plans were deemed as clinically improved and equally compared with the manual plans, respectively. The average CI for the PTV was 0.88 and 0.80 for the auto and manual plans respectively. Compared with the manual plans, the mean doses of all the OARs in the auto plans were reduced by 11% in average. The average elapsed time of automatic planning and manual planning was (28.15±3.61) and (36.7±4.6) min, respectively.Conclusions:The plans created by the proposed algorithm have been shown to be at least as good as the manual plans. In addition, this method can shorten the labor time in plan designing while ensuring the plan quality and consistency of the plan.

Objective:To investigate the performance of W2 plastic scintillator in megavolt photon and electron beams.Methods:The photon and electron beam energy provided by linear accelerator was used to collect data of the W2 scintillator. The parameters include the electrometer reading stability, W2 dose and dose rate linearity, and angular response. And the dose uncertainty of the W2 correction factors was also investigated.Results:The standard deviation of the electrometer reading stability was between 0.03 and 0.47. The linear regression factors of W2 dose were all 1.0; the maximum deviation of the dose rates was 0.61%. The Cerenkov light radiation correction factor(CLR) for 6 and 10 MV were 0.741 and 0.746, respectively, and the CLR for 6, 9, 12 and 15 MeV were 0.750, 0.753, 0.757 and 0.757, respectively. The maximum deviation of dose uncertainty for 15 MeV was 3.15%.Conclusions:The signal obtained by the blue and green channel was no angular dependence, the same as the high-energy electron beam, which verified that the Cerenkov radiation correction factor has good linearity. W2 plastic scintillator can be applied to non-coplanar radiotherapy dosimetry.

Objective To investigate the transfer rate of alkaloids in extraction and purification process of Cortex Phellodendri Amurensis (CPA) and to ascertain the optimal purification technology.Methods We purified the alkaloids from Cortex Phellodendri Amurensis by AB-8 macroporous resin.With the contents of berberine hydrochloride and palmatine hydrochloride as the reference indexes,content determination of alcohol extract,sample solution and eluent from AB-8 macroporous resin were determined by HPLC.Results The optimal technology was as follows:using 8-fold 75 %(V/V) ethanol as extract,extracting for 3 times and lasting one hour for each time.The transfer rate of alkaloids was 83.75 %under the above condition.The transfer rate of alkaloids was about 80 %when the concentration of sample solution(pH value being 8 and centrifugation) was 0.1 g/mL,and the transfer rate of alkaloids in eluent was 75.14 %.Conclusion The optimum technology is stable and feasible,and the purification effect of alkaloids from Cortex Phellodendri Amurensis by AB-8 macroporus resin is good.