Objective To assess the feasibility of applying intensity-modulated radiotherapy(IMRT)simultaneous integrated boost(SIB)to replace conventional radiotherapy(CR)plus brachytherapy of whole pelvis in locally advanced cervical eaneer(LACC).Methods Five LACC patients based difference position of uterus were chosen and worked out CR and IMRT SIB plans respectively.Dose distributions were compared between IMRT SIB and CR.Results When uterus was in ante-,neutral-,retro-pnsition and deviation respectively,IMRT SIB could provide enough and homogeneous dose distribution for target volume and reduce irradiated volumes and doses for organs at risk(recta,bladder and small intestine)than CR.The doses of the A,B,and fundus of uterus were higher in IMRT SIB than CR.However,in ease of small intestine was close to or encircled the uterus,the targets volume dose would be inadequacy.Conclusions LACC IMRT SIB's dose distribution is better than CR(except excess ante-position)and may help to treat those patients who couldn't be suitable with brachytherapy.

Objective To study sex differences,in common risk factors,subtypes and outcomes in stroke.Methods 2912 patients hospitalized for stroke were evaluated for common risk factors,subtypes and outcomes data.Results Mean age was higher in women than in men(P

Objective To understand the change of transient bacteria on surface in clinical ward before and after terminal disin‐fection ,provide the basis for controlling of hospital infection .Methods Surface samples were collected before and after terminal dis‐infection in infected patch of our hospital ,and then bacterial in the samples were cultured and identified .Compared changes about number and type of samples bacterial ,distribution of common clinical pathogenic bacteria before and after of the terminal disinfec‐tion .Results The surface colony number < 10 CFU /cm2 accounted for 63 .54% after terminal disinfection ,compared with the dis‐infection before 56 .29% ,increased 7 .25 percentage points .Surface sampling microorganism detecting rate decreased by 6 .74% . Surface average bacteria colony had different degree decreased before and after disinfection ,except the bed frame and quilt cover . Water tap ,which was the largest amount of bacteria surface ,followed by the bedside table .Before and after disinfection ,the mainly common microorganism was environment bacteria in infected patch ,including coagulase negative staphylococcus ,gram positive ba‐cilli ,Micrococcus ,Acinetobacter spp .Clinical common pathogenic bacteria mainly isolated from the department of brain surgery (9 .49% ) ,department of hepatology(8 .76% ) ,department of dermatology (8 .76% ) ,department of pediatrics (8 .03% ) ,emergency department (7 .30% ) .Pathogenic bacteria living areas were mainly the bedside table (21 .17 % ) ,water tap (18 .25% ) ,bed rest (12 .41% ) .Conclusion Terminal disinfection could effectively reduce the number of bacteria in the infected patch ,improve the ward environmental sanitation quality ,it have an important significance in the prevention of hospital infection control .

Objective To summarize the application of ATP bioluminescence assay in surveillance of terminal disinfection of effects ,so as to provide the basis for intervention of disinfected effects .Methods ATP bioluminescence assay were employed to randomly test the surfaces of operating objects in therapeutic rooms and beside tables in wards ,total 144 object surfaces ,of each clinical departments in the whole hospital .The values of ATP bioluminescence assay were read on‐site ,0-250 RLU was recognized as qualification ,while disqualification when >250 RLU .The disqualified object surfaces were performed on‐site intervention that all of them were re‐disinfected ,the results were compared .Results Both the surfaces of operating objects and beside tables were dis‐qualified before disinfection ,and the values of ATP bioluminescence assay were 780 ± 10 .34 RL and 853 ± 13 .29 RLU respectively . The pass rates of ATP bioluminescence assay was 61 .97% of operating surfaces and 79 .45% of beside table surfaces the first dis‐infection .The disqualified sites were retested following on‐site intervention .The values of ATP bioluminescence assay were 431 .02 ± 0 .53 before intervention and 1 .43 ± 0 .59 after intervention ,and the difference was statistically significant .Conclusion ATP bi‐oluminescence assay can get more immediately ,simple and timesaving in evaluating the effect of disinfection and estimate the effi‐ciency of disinfection timely ,which can also provide the scientific basis on on‐site intervention so as to improve the execution power of hospital infection management .

Objective To understand the homology of clinical isolates from patients with carbapenem-resistant Klebsiella pneumoniae(CRKP)infection and isolates from environment in a medical institution.Methods One CRKP strain isolated from a patient in this hospital and 4 strains of Klebsiella pneumoniae(K.pneumoniae)isolated from patient's surroundings were collected,susceptibility of 5 strains to commonly used antimicrobial agents was detected,production of carbapenems in 5 strains were detected by modified Hodge testing and carbapenem inactivation method(CIM),homology analysis was performed by pulsed-field gel electrophoresis(PFGE).Results Antimicrobial susceptibility testing results showed that 5 strains of K.pneumoniae(1 from patient,4 from the patient's ward surroundings,including hands of nursing aides,solution bottle opening,handle for lifting and dropping bed,and bedrail)were all resistant to other antimicrobial agents except to cephamycin and aminoglycosides.The modified Hodge testing and CIM confirmed that 5 strains all produced carbapenemases;PFGE results showed that electrophoretogram of CRKP isolated from solution bottle opening of ward,bedrail,and handle for lifting and dropping bed were the same as CRKP isolated from patient,while electrophoretogram of CRKP isolated from hands of nursing aides had 2 different bands,there was a close relationship between the strains.Conclusion The same type of CRKP were isolated from patient and his surroundings,it is necessary to implement healthcare-associated infection(HAI)control system,isolate infected patient,and strengthen environmental cleaning and disinfection,so as to avoid the outbreak of HAI.

The mechanism of sudden cardiac death caused by variation in SCN5A is still unclear. Recently, the converging evidences suggest that the dysfunction of regulation mediated by transforming growth factor-β1 in cardiac fibration and reconstruction of cardiac iron channel could be main reason of SUNDS caused by variation of SCN5A. The resent progress of the mechanism of transforming growth factor-β1 in sudden cardiac death caused by variation of SCN5A gene is reviewed in this paper, hoping to provide reference for the research and practice of sudden cardiac death in forensic medicine.

Objective To investigate the anatomy of upper cervical vertebrae's stable reconstruction by poster arch of atlas screw by anatomic study. Methods To collect the anatomical data of 39 dry atlas with the average inner diameter of vessel of atlas, the average high and wide of the screw point of poster arch of atlas, the average high and wide of poster arch of atlas beneath the groove for vertebral artery, the tract length of poster arch screw, the tract length of lateral mass screw, the direction and angle of poster arch screw, and the direction and angle of lateral mass. Statistical comparison were performed with Student test between the tract length of poster arch screw and the tract length of lateral mass screw. Results The average inner diameter of vessel of atlas was (26.8±2.58) mm(21.7-31.0 mm). The screw point high and wide of poster arch of atlas were (6.83±1.97) mm and (6.40±1.36) mm respectively. The average high and wide of poster arch of atlas beneath the groove for vertebral artery were (4.37±1.11) mm and (8.05±1.33) mm respectively. The tract length of poster arch screw were (30.54±1.705) mm. The direction and angle of poster arch screw was 15°-20° incline laterally and 0°-5°incline cephalo. 25.6%(10 cases) patients with the diameter less than 3.5mm beneath the groove for vertebral artery. The direction and angle of lateral mass screw was 32.05°±6.03° incline medially and 5° incline cephalo. There were significant differences between the tract length of poster arch screw and the tract length of lateral mass screw(t=59.528, P＜0.001 ). Conclusion About 74.4% patients can reconstruct the upper cervical stable by poster arch of atlas screw. The technique can gain instant upper cervical stable, and reduce the risk of injury of blood vessel by over explore the atlas arch compare with the technique of lateral mass screw fixation of atlas. The technique is worth to promoting with its character of safe, easy perform and rigid fixation.

Objective To analyze the dosimetfic benefits, clinical effect and side-respond of whole breast using intensity modulated radiotherapy for early breast cancer after conservative surgery. Methods From Oct.2004 to Aug. 2005,103 patients received the whole breast intensity modulated radiation therapy (IMRT). A dosimetric comparison of IMRT with conventional radiotherapy (CR) was performed on each patient. The cosmetic results, clinical effect and side-respond were observed. Results The average volume proportion of 95% and 107% prescribed dose was 95.8% ± 4.90% and 84.0% ± 20.7% (t = 9.60, P < 0.01) with IMRT and CR in clinical target volume, respectively. The V20 (lung volume of aceepted> 20 Gy/all lung volume × 100%) of the ipsilateral lung were 15.70% ± 4.64% and 23. 11% ± 7.88% (t = - 13.3, P < 0.01). The V30of the heart were 4.44% ±3.93% and 15.55% ± 10.89%(t = - 11.3, P< 0.01) with IMRT and CR respectively for sixty-three left side breast cancer patients. The 1- and 2-year excellent rate of good cosmetic outcome was both 100%. The 1-, 2- and 3-year local control rate was 99% ,99% and 98% ,respectively. The 1-, 2- and 3-year disease-free survival rate was 99% ,99% and 96% ,respectively. The Grade 1 and 2 acute radiation skin reaction rate was 95.1% and 4.9%, respectively. Conclusion Compared with conventional radiotherapy, IMRT improves dose distribution of CTV and reduce the dose of normal tissue around CTV;but with better clinical effects and lower side-respond for early breast cancer patients after breast conservative surgery.

A rapid resolution liquid chromatography quadrupole time-of-flight mass spectrometric ( RRLC-QTOF/MS) method was used to profile the metabolites of urine samples from atherosclerosis ( AS) patients and healthy controls and find the differential metabolites which could provide the scientific evidence to explain the pathogenesis and early disease diagnose. In the study, 15 AS patients ( age46. 84±2. 41 years) and 15 healthy controls ( age45 . 72±1 . 93 years ) was screened out by VaSera VS-1000 . The urine samples were analyzed by RRLC-QTOF/MS and the resulting data matrices were analyzed by multivariate statistical analysis ( Principal Component Analysis, PCA ) to find the potential biomarkers. The results showed that the urine samples of AS patients were successfully distinguished from those of healthy controls. Besides, a total of two significantly changed metabolites, uric acid and Guanidineacetic acid, had been found and identified as potential biomarkers, which suggested that the disorder of purine metabolism and amino acid metabolism played an important role in the mechanism of AS.

Objective To evaluate the efficacy of ancient classical prescriptions treating middle and advanced primary liver cancer.Methods Articles were searched from Pubmed, Embase, SCI, Cochrane Liarary and CNKI, VIP, WanFang Data, CBM databases. Randomized controlled trials about ancient classical prescriptions treating advanced primary liver cancer were collected. Results 17 studies were included, a total of 994 patients. The recent efficiency of ancient classical prescription combined with symptomatic therapy increased by 28% compared with single supportive and symptomatic therapy;the stable rate of life quality increased by 23%;the efficiency of TCM syndrome increased by 29%;the survival rates of 3 months, 6 months and 1 year increased by 16%, 36.7% and 58.5% respectively;the life quality score of later increased by 6.29 on average. Conclusion Ancient classical prescription combined with supportive and symptomatic therapy in advanced primary liver cancers is superior to single supportive and symptomatic therapy on recent efficiency, survival rate (3 months/6 months/1 year), quality of life and TCM syndrome. The conclusion of this study needs randomized controlled trials with larger samples, multicenter and high quality for further verification.