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 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 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 .

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 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.

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

OBJECTIVETo explore rest, cold compress and elevate (RICE) with rest, compress and elevate (RCE) without cold for the treatment of acute ankle sprain, in order to clear mid-term clinical effects.

METHODSEighty-nine patients with acute ankle sprains were collected from January 2013 to March 2014,including 30 males and 59 females aged from 18 to 60 years old with an average of 36 years old; the time from injury to hospital ranged from 3 to 24 h with an average of 9 h. All patients were divided into two groups according to visiting sequence. There were 45 patients in RICE group, and 45 patients in RCE groups. The main therapeutic effect index was evaluated by Karlsson scoring, and secondary therapeutic effect index was pain and satisfactory VAS scores. Safety index evaluated by adverse event.

RESULTSOn the 2nd weeks after injury, Karlsson score in RICE group was 44.66 ± 11.58, and 46.67 ± 8.52 in RCE group, while there was no statistical significance between two groups in Karlsson scores (P > 0.05). Karlsson score of two groups after treatment were higher than before treatment. There was no significantly meaning in pain and satisfactory VAS scores between two groups (P > 0.05). No adverse reaction were occurred between two groups.

CONCLUSIONCold compress did not receive much more final gains, and no evidence showed cold compress could affect recovery of joint function.

Acute Disease ; Adolescent ; Adult ; Ankle Injuries ; physiopathology ; therapy ; Case-Control Studies ; Cold Temperature ; Female ; Humans ; Male ; Middle Aged ; Sprains and Strains ; physiopathology ; therapy

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 compare the dosimetric difference between RapidArc and fixed gantry angle dynamic IMRT (dIMRT) for central-type lung cancer radiotherapy. Methods Therapy for 10 patients previously treated with dIMRT was replanned with RapidArc. Dose prescription was 66 Gy/33 fraction. Comparative endpoints were planning target volume (PTV) dose, doses to surrounding structures,number of monitor units, and treatment delivery time. Results There was no significant dosimetric difference between RapidArc and dIMRT. Compared with dIMRT, RapidArc slightly elevated target volume dose, lung V5, V10. The average values of lung V20, V30 and heart V30 were larger in dIMRT than those in RapidArc. The number of monitor units was reduced by 32% and the treatment time by 66% in RapidArc.Conclusions Both RapidArc and dIMRT plans could meet the clinical therapy needs. RapidArc could achieve similar target coverage and sparing of organs at risk, with fewer monitor units and shorter delivery time than dIMRT.

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.