Objective To identify the key factors triggering medical disputes induced by differences in cognition between doctors and patients in order to control the occurrence and development of medical disputes. Methods From 2002 to 2006,the outpatients,inpatients and medical staff of 3 hospitals in Shanghai(class 3 first level general hospital,n=2;class 3 first level special hospital,n=1) were investigated,and random sampling method was employed for the research analysis. Results There were significant differences between doctors and patients in cognition of influential factors triggering medical disputes such as health law,medical services,rights and obligations. Conclusion The differences in cognition between doctors and patients are important causes for medical disputes,and effective prevention and intervention measures must be taken.

Objective To analyze the normal lung dose-volume histogram(DVH) varieties in the former and later period(P1 and P2)of three dimensional conformal radiation therapy(3DCRT) plans and the compound (Pc) plan in non-small cell lung cancer(NSCLC),and to access the feasibility to modify the target volume during the treatment course.Methods Twenty-one NSCLC patients who had received accelerated hyper-frationation 3DCRT in P2 were included in the study.Both of the P1 and P2 plans were redesigned to a total dose of 70 Gy with V20 smaller than 35%.When the target volume was modified and P2 plan was rede signed using accelerated hyper-frationation 3DCRT of 30 Gy after P1 plan of 40 Gy,the Pc plan was compoun ded by transmitting the parameters(such as target volume,irradiation field and dose) of P1 plan into P2 plan. Total lung volume and target volumes(GTV,PTV) of P1 and P2 were evaluated.MLD,V5,V10,V20 and V30 of P1,P2 and Pc were calculated.Results The total lung volume in P1 and P2 plans was not significantly dif ferent(t = 0.19,P = 0.850).The volumes of GTV,PTV in P2 were obviously smaller than P1 (t = 2.88,P = 0.009 ; t = 4.01 ,P = 0.001) .When comparing P2 with P1 ,MLD were 16.5 Gy Vs 17.8 Gy (t = 2.60, DOI:10.3760/cma.j.issn.1004-4221.2009.01.057 P = 0.017),V30 was significantly decreased (t = 2.19,P = 0.041),but V5,V10 and V20 had no significant difference.Similar differences were found in MLD,V5 ,V10 ,V20 and V30 when comparing Po to P1.P2 plans had significantly smaller MLD,Vs,V10,V20 and V30 than Pc plans.Fourteen patients with decreased PTV were further analyzed.The V30 and MLD decreased significantly (t = 3.00,P = 0.0 I 0;t = 2.38,P = 0.033), but V5 ,V10,V20 had no difference when comparing P1 and P2 plans.Among these 14 patients,the V10 and V30 decreased significantly(t = 2.76,P = 0.033 ; t = 3.60,P = 0.011) when P2 plans were generated using the same field number and beam angles in P1 plans in 7 patients.The parameters were similar in P1and Pc plans,but increased significantly when comparing to P2.Various parameters were the same among P1,P2 and Pc plans when P2 plans were designed using 1-2 different fields and angles in the other 7 patients.The differ ences were not significant between P1 and P2 plans in 7 patients with the same or increased PTV.Expansion or contraction of PTV significantly influenced MLD and V2o (r =-0.62,P = 0.03 ; r = O.48,P = 0.029). Conclusions When the tumor regresses,the high dose volume of the lung decreases with modifying the tar get volume and replanning in the later period using accelerated hyper-frationation 3DCRT.The low dose vol ume of the lung may decrease if the field orientations are same throughout the treatment.It is rational to eval uate the normal lung DVH of the whole plan when the physical parameters of the later period plan are the same as the former one.

Adult ; Antibodies, Monoclonal ; analysis ; DNA Nucleotidylexotransferase ; metabolism ; Female ; Follow-Up Studies ; Humans ; Keratins ; immunology ; Male ; Middle Aged ; Prognosis ; Thymoma ; metabolism ; pathology ; surgery ; Thymus Neoplasms ; metabolism ; pathology ; surgery

Adolescent ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; Cyclophosphamide ; administration & dosage ; Diagnosis, Differential ; Doxorubicin ; administration & dosage ; Female ; Hodgkin Disease ; pathology ; Humans ; Lung Neoplasms ; pathology ; Lymphoma, B-Cell ; drug therapy ; pathology ; surgery ; Male ; Mediastinal Neoplasms ; drug therapy ; pathology ; surgery ; Mediastinum ; surgery ; Neoplasm Invasiveness ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; pathology ; Prednisone ; administration & dosage ; Thymoma ; pathology ; Thymus Neoplasms ; pathology ; Vincristine ; administration & dosage

Objective To investigate the xenotransplantation model of fetal pig skin precursor tissue and its development after transplantaion. Methods Porcine skin precursor tissue was obtained from the embryo of gestation day 56 (E56), and made into microskin or stamp skin graft. The microskin was transplanted to the dorsal wound in BALB/c nude mice, then covered with human corpse skin. The stamp skin graft was imbedded subcutaneously into the back of nude mice, and microskin was injected subcutaneously into the auricles of nude mice. Their growth and development were observed and they were examined by HE staining at 6th and 12th week after transplantation respectively. Two-sample t test was used to analyze the size of newly grown skin tissue. Results Porcine skin precursor tissue graft in three models above survived and continued growth after transplantation, and growth ability of the dorsal wound transplantation model was significantly stronger than that of the auricle model. Epidermis and hypodermis were detected in newly grown skin tissues. Hair follicles, a few of sebaceous glands, but no sweat glands were observed in auricle model, while many sebaceous glands and sweat glands were observed in the dorsal wound model. Conclusion Transplantation of microskin to dorsal wound is the optimal model of investigating the xenotransplantation of fetal pig skin precursor tissue and its development after transplantion.

Objective To understand the changes and possible mechanism of the blood brain barrier(BBB) permeability induced by tumor necrosis factor(TNF-?) in vitro.Methods BBB model was established by coculturing allogenic brain microvessel end othelial cell(BMEC) and astrocyte(AS).The BBB model was divided randomly into normal control group,TNF-? group and Y-27632 pretreatment group.The changes of BBB permeability were evaluated by Gamma radioim muno assay counter.Results The Gamma radioimmuno assay indicated that the marker,~(125)I-BSA,across the BBB model in vitro was significantly increased after TNF-? treatment compared with control group,Y-27632 pretreatmen could prevent the permeability of BBB induced by TNF-?(P

OBJECTIVE: To investigate the characteristics of air-conducted ocular vestibular-evoked myogenic potential (oVEMP) in healthy young people , so as to establish the normative data of young people. METHOD: Fifty-five healthy young subjects were recruited as study participants, 500 Hz air-conducted tone burst was used as stimulation. The threshold of oVEMP in each ear was examined. The latencies of P1 and N1, P1-N1 interval, peak-to-peak of P1-N1 amplitude and asymmetry ratio were measured. Effects of gender on oVEMPs were also exam- ined. RESULT: The typical complex wave of N1 and P1 was observed in all subjects. The threshold of oVEMP examination was(82.23 ± 12.92) dBHL, 95 dBHL air-conducted get the latencies of P1 and N1, P1-N1 interval,peak-to-peak P1-N1 amplitude in these healthy young people were(11.53 ± 0.80)ms, (16.61 ± 0.87)ms, (5.18 ± 11.04)ms, (5.96 ± 2.59)μv, respectively. The peak-to-peak P1-N1 amplitude of male was (6.49 ± 2.67) μv ,the female was (5.21 ± 2.34) μv, there were significant differences between male and female subjects in the wave amplitude (P < 0.05). CONCLUSION Air-conduction induced oVEMP is a new method for vestibular function test. The amplitude of the oVEMP wave was different between male and female. Therefore it is necessary to establish the normal value according to genders.
Acoustic Stimulation ; Eye ; Female ; Head ; Humans ; Male ; Reference Values ; Vestibular Evoked Myogenic Potentials ; Vestibular Function Tests ; Vestibule, Labyrinth ; Young Adult

ObjectiveTo investigate the prevalence of syphilis among outpatients in sexually transmitted disease (STD) clinics in Guangxi Zhnang Autonomous Region,and to assess the socioeconomic and behavioral factors associated with the infection.MethodsThe outpatients to 14 STD clinics in 8 cities of Guangxi Zhnang Autonomous Region were investigated with questionnaires by their doctors at the first visit.Venous blood samples were obtained from these outpatients and subjected to toludine red unheated serum test (TRUST) to screen for syphilis.Treponema pollidum particle agglutination (TPPA) was performed for TRUSTpositive samples.The epidemiological data were collected by using EpiData software,statistically analyzed by using SPSS13.0 software package.ResultsA total of 10 930 STD outpatients were recruited in the study,and 1297 samples were confirmed to be both TRUST and TPPA positive.The prevalence of syphilis was 11.9％ in all of the outpatients,14.3％ in female outpatients and 10.3％ in male outpatients,13.3％ in the outpatients of Zhuang nationality,and 11.4％ in those of Han nationalily.Multivariate analysis showed that syphilis was independently related to female sex[odds ratio(OR) 2.23,95％ confidence interval(CI) 1.69 - 3.00,P＜0.01 ],low educaiion level (middle school:OR 1.70,95％ CI 1.11 - 2.62,P ＜ 0.05; primary school or illiteracy,OR 1.98,95％ CI 1.13 - 3.46,P＜0.05),annual income of more than 30000 Yuan (OR 1.91,95％ CI 1.18 -3.10,P ＜ 0.01 ),commercial sex workers or having multiple sexual partners(OR 1.54,95％ CI 1.16 - 2.06,P ＜0.01 ).ConclusionsSyphilis serology should be the routine test in STD clinical settings in Guangxi region,and the intervention should be enhanced to control the prevalence of syphilis in high-risk populations.

Objective To identify the best technique of postmastectomy radiation therapy (PMRT).Methods Twenty-eight patients with stage Ⅱ or Ⅲ invasive breast cancer were treated with modified radical mastectomy and radiotherapy sequaciously involving the supraclavicular region and the chest wall.Three different techniques were developed for each patient:two tangential conformal fields ( half field) in the chest wall plus supraclavicular intensity modulated radiotherapy (3D-CRT + IMRT),integrated chest wall and supraclavicular IMRT(IMRT),and two tangential conformal fields (half field) in the chest wall plus single field electron beam radiotherapy in the supraclavicular region( 3D-CRT + E).The dose distributions of the target areas and the irradiated volumes of the ipsilateral lung ( V5,V10,V20,and V45)were estimated with the dosage volume histogram (DVH).The dosage prescription was 50.4 Gy (1.8 Gy × 28 f).Results The conformity index (CI) of the 3D-CRT + IMRT group was (0.61 ± 0.03),not different from that of the IMRT [ (0.62 ±0.03),q =2.16,P ＞0.05],and the CI levels of these 2 groups were both higher than that of the 3D-CRT + E group [ (0.44 ± 0.02 ),q =20.50,22.66,P ＜0.01 ].The heterogeneity index (HI) of the 3D-CRT + IMRT group was ( 1.17 ±0.02),not different from that of the IMRT [ (1.15 ±0.02),q =1.66,P ＞0.05],and the HI levels of these 2 groups were both lower than that of the 3D-CRT + E group[ ( 1.24 ±0.04),q =3.91,5.58,P ＜0.01 ].The levels of V5 and V10 of the ipsilateral lungs of the 3D-CRT + E group(48.70％ ±3.24％,38％.56％ ±3.70％ ) and 3D-CRT + IMRT group (49.12％ ±3.03％,38.38％ ± 3.56％ ) were all significantly lower than those of the IMRTgroup [(77.18％ ±8.01％,53.07％ ±6.85％),V5,q =20.35,20.05,P＜0.01; V10,q=12.10,12.24,P ＜0.01 ] and there were not significant differences in the V5 and V10 levels between the 3D-CRT + E and 3D-CRT + IMRT groups ( q =0.30,0.14,P ＞ 0.05 ).The levels of V20 of the ipsilateral lungs of the 3D-CRT + IMRT group (26.57％ ±2.51％ )and IMRT group (25.22％ ±2.77％) were all significantly lower that those of the 3D-CRT + E group [ (31.79％ ± 3.00％ ),q =5.27,8.21,P ＜ 0.01 ]and there were not significant differences in the V20 level between the 3D-CRT + IMRT and IMRT groups (q=2.76,P ＞ 0.05 ).There were not significant differences in the V45 levels among these 3 groups (F =0.69,P ＞ 0.05).Conclusions The 3D-CRT + IMRT technique in PMRT effectively reduces the radiated dose on the ipsilateral lung.

Objective To investigate the dosimetric influence of pure carbon fiber treatment tabletop of Elekta Precise new linear accelerator in radiotherapy.Methods Surface-axis distance (SAD) technology was employed for the measurement.Two groups of fields were set and both of them were SAD opposed portals ( one of them went through the tabletop,while the other did not).A PTW electrometer and a 0.6 cm3 Farmer ionization chamber were utilized for comparison measurement.Then dose attenuation of the main table board,extended body board,the extended board for head,neck and shoulders,and the joints of these boards were calculated.Results Under the energy of 6 MV,the dose attenuations of the following locations were:1.4％ - 7.2％ at the main treatment table board; 2.8％ - 38.7％,1.4％ -30.1％,1.5％ -20.8％ and 1.4％ - 11.2％,respectively at distances of 1,4,7 and 8 cm from the joint of the main table board ;0.5％ - 5.0％ at the extended body board; 4.7％ - 15.4％ at distance of 1cm from the joint of the extended body board; 0.5％ -3.3％ at the neck position of the extended board for head,neck and shoulders; 5.3％ - 16.7％ at the shoulder positions; and 6.8％ -30.4％ at the joint between the extended boards and the main table board.Conclusions The dose attenuations of the new linear accelerator pure carbon fiber treatment tabletop vary at different locations. Considerable higher attenuations are observed at the table board joints than other locations.