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.

OBJECTIVE To enhance the hospital infection control quality level,decreasing hospital infection incidence and safeguarding the medical treatment in community health servnice canter(CHSC).METHODS Through plan,do,check and action(PDCA) circle method,combined with the management analysis the risk factors were found,and the method was useful for improving hospital infection control quality.RESULTS After one and a half years all-process progressive improvement of our work,the risk factors were diminished,the quality evaluation was improved and the management was more effective.CONCLUSIONS Practicing scientific management to improve control quality,can effectiely enhance the hospital infection control quality.

OBJECTIVE： To investigate in vitro antibacterial activity of the extracts from the root， stem and leaves of Psychotria rubra， and to investigate its mechanism of antibacterial effects. METHODS： 95％ ethanol extracts from the root， stem and leaves of P. rubra were used to prepare solution with mass concentration of 100 mg/mL （calculated by extract）. Using as penicillin sodium （0.5 mg/mL） and streptomycin sulfate （128 mg/mL） as positive control， plat stiletto method was used to determine antibacterial effects of the extracts from different parts of Staphylococcus aureus， Escherichia coli， Pseudomonas aeruginosa， Bacillus subtilis， Micrococcus luteus and Enterococcus faecalis. Using systematic solvent extraction method， the petroleum ether， ethyl acetate and n-butyl alcohol were used to extract antibacterial activity parts from P. rubra as ad to obtain the extracts of corresponding polar parts. After preparing 100 mg/mL drug solution （calculated by extract）， antibacterial effects of above 6 kinds of bacteria were investigated. The micro-broth dilution method and agar culture medium plate method were used to determine minimum inhibitory concentration （MIC） and minimum bactericidal concentration （MBC）， and screen polar parts with bacteriostasis and drug-sensitive strains. Under the concentration of 0.5MIC and MIC， the growth curves of sensitive bacteria were drawn （treated for 36 h， every 4 h）； the contents of alkaline phosphatase （AKP） and soluble protein were detected in suspension （treated for 10 h， every 2 h）； bouillon culture medium instead of the extract as blank control. RESULTS： 100 mg/mL ethanol extracts from the root， stem and leaves of P. rubra showed good antibacterial effect to above 6 kinds of bacteria， in descending order as stem＞leaves＞root. Among different polar parts from the stem of P. rubra， antibacterial effect of the ethyl acetate extract was best， especially for the S. aureus， the diameter of inhibition zone reached （38.93±0.12） mm， and both MIC and MBC were 0.39 mg/mL. The ethyl acetate extract could significantly inhibit the proliferation of S. aureus， and its alkaline phosphatase and protein content in suspension were increased significantly compared with blank control （P＜0.05）. CONCLUSIONS： The stem from P. rubra is effective antibacterial parts， and exhibit good antibacterial activity to 6 kinds of common pathogens. The ethyl acetate extract from the stem of P. rubra shows strongest antibacterial effect on S. aureus， and could gradually destroy the integrity of cell wall and cell membrane.

Objective To investigate the efficacy and safety of fluid resuscitation with 75 g/L NaCl solution in traumatic hypovolemic shock using Meta-analysis. Methods Based on the inclusion criteria,the randomized controlled trials (RCTs) were identified by retrieving the databases including PUBMED,EMBASE,OVID,Cochrane library and EBSCO.The quality of studies was also evaluated.Indices including systolic blood pressure,hemoglobin,serum Na level and mortality were extracted from the enrolled RTCs and were comparatively analyzed between the 75 g/L NaCl group and the isotonic saline group for evaluating the safety and efficacy of 75 g/L NaCI solution.The extracted data were analyzed by using the Review Manager 5.0.25. Results Six RCTs were eligible for Meta-analysis.The 75 g/L NaCl group displayed remarkable increase in systolic blood pressure and decrease in hemoglobin level,compared with the isotonic saline group ( MD =6.23,95％ CI 2.78-9.69,P ＜ 0.01 ; MD =-6.11,95％CI -8.25-3.96,P ＜ 0.01,respectively).Short-term hyperosmolar state in 75 g/L NaCl group was increased significantly but was considered acceptable ( MD =7.97,95％ CI 7.55-8.38,P ＜ 0.01 ).No significant difference in mortality was found between 75 g/L NaCl group and isotonic saline group ( RR =0.96,95％ CI 0.84-1.10,P ＞ 0.05). Conclusion Fluid resuscitation with 75 g/L NaCl solution is safe and effective for traumatic hypovolemic shock.

Objective To investigate the biological functions of IncRNA-BG on the radiosensitivity of normal human bronchial epithelial cell line Beas-2B.Methods Three IncRNA-BG siRNAs were designed,synthesized and traasfected into Beas-2B cells via lipofectamine.The RNA transcription level of BG was detected by quantitative real time-PCR to confirm the siRNA transfection efficiency.The experiment was divided into control group,control siRNA transfected group,and BG transfected group.Cell survival was detected by clonogenic assay,and the cell cycle distribution was determined by flow cytometry assay.The γ-H2AX foci formation after irradiation was visualized via immunofluorescence.Western blot assay was performed to detect the protein expressions of RAD50,p-P53,KU70,KU80,MDM2,CDK2 and RB.Results BG-siRNA transfection significantly reduced the BG transcription level (t =8.32-15.29,P ＜0.05) and increased cell survival after irradiation at 0.5,1,2,4 and 6 Gy.Analyzed with the multi-target model,the SERD0 of Beas-2B cells and control siRNA transfected cells were calculated to be 0.80 and 0.82,respectively.In addition,BG-siRNA transfection enhanced radiation-induced cell cycle arrest at G2 phase so that,after 4 Gy irradiation,the cells in G2 phase was increased from (37.37 ±0.63) ％ of control siRNA cells to (64.19 ± 1.01) ％ (t =30.65,P ＜ 0.05).Meanwhile,the γ-H2AX foci of BG-siRNA transfected cells was decreased from 76 ± 1.78 per 100 cells to 59-± 3.49 per 100 cells (t =13.72,P ＜0.05).The expressions of DNA damage related proteins including KU70,KUS0,CDK2 and RB were increased,but the expressions of p-P53 and RAD50 were decreased.Conclusions LncRNA-BG could regulate the radiosensitivity of the normal human bronchial epithelial cells,probably through inducing cell cycle G2 phase arrest and promoting DNA damage repair after irradiation.

Objective To investigate the probability of high mobility group box 1 protein as a biological dosimeter of ionizing radiation. Methods The medium of cultured human fibroblast cell line GM was collected 24 h after exposed to 60Co γ-rays, and HMGB1 protein concentration was detected by ELISA assay, and the dose-effect curve was then fitted. The levels of HMGB1 protein was also detected after exposed to 4 Gy irradiation at 24,48 and 72 h. Results The level of HMGB1 protein in culture medium was increased in a dose-dependant way, and the dose-effect curve of HMGB1 level for 24 h after irradiation fitted the linear model y = 0.5655 + 0.0358x (r = 0. 9339) . After exposure to 4 Gy irradiation, the levels of HMGB1 protein in the culture medium were also increased time-dependently.Conclusion The release of HMGB1 protein to neoplasm is reactivated by irradiation in GM cell. It is necessary to further the studies on HMGB1 as biological dosimeter for radiation injury protection and therapy.

Objective To determine the prevalence of rapid eye movement(REM)sleep behavior disorder(RBD)in patients with Parkinson' s disease(PD)and to investigate the risk factors of PD-RBD and its effect on the progress of PD. Methods Using the minimal diagnostic criteria of parasomnias described in the International Classification of Sleep Disorders-Revised(ICSD-R)to diagnose clinically probable RBD(cpRBD), patients were assessed by Unified Parkinson's Disease Rating Scale(UPDRS),MMSE, Montreal Cognitive Assessment(MoCA)at baseline and followed for 2.5 years. Results The frequency of cpRBD ranged from 35.6%(47/132)to 41.7%(55/132)during the study period. 11.4% (15/132)patients dropped out from the study. Lower MoCA score and type of onset are independent factors with cpRBD; Lower MoCA score(OR =0. 817 ,P =0. 004)is the risk factor while tremor(OR =0. 247 ,P =0. 020)is the protective factor. PD in patients with PD-RBD may progress more rapidly than non PD-RBD patients(UPDRS Ⅲ change from baseline 9. 86 ± 4. 96 vs 6. 76 ± 4. 26, t = 2. 909, P = 0. 005; H-Y change from baseline 0. 77 ± 0. 54 vs 0. 33 ± 0. 49, t = 3. 664, P = 0. 000). Conclusion RBD may be a symptom predictive for rapid PD progression, declining cognition and psychosis.

Objective To investigate the microbiological trends and antibiotic susceptibility of peritoneal dialysis(PD)-related peritonitis (PDAP).Methods All patients who developed PDAP between 2004 and 2015 in Renji Hospital,Shanghai Jiao Tong University School of Medicine were enrolled.Demographic data,results of dialysate pathogen culture and drug susceptibility test were recorded.The trend of peritonitis incidence was measured by Poisson regression and the chi-square test or Fisher exact test method was used to compare the composition of causative organisms and their antimicrobial susceptibilities over time.Results During the study period,a total of 711 episodes of PDAP were occurred in 386 patients.The culture positive rate of pathogens rose from 52.0％ in 2004 to 77.0％ in 2015 (P ＜ 0.001).The distribution of causative organisms of the culture positive peritonitis was gram-positive bacteria (270,59.5％),followed by gram-negative bacteria (129,28.4％),polymicrobial(39,8.6％),fungi (15,3.3％) and mycobacteria (1,0.2％).From 2004 to 2015,the incidence of peritonitis decreased from 0.214 to 0.160 episodes/patient·year (P=0.034).The incidence of coagulase-negative staphylococcus peritonitis decreased from 0.049 to 0.027 episodes/patient · year (P=0.025),while others had no significant change;A significant decline was observed in the sensitivity of Gram-positive strains to the first generation cephalosporin and ampicillin/sulbactam in 2010-2015 group compared with those in 2001-2009 group (61.3％ vs 88.2％,P ＜ 0.001;61.7％ vs 85.5％,P=0,001),whereas the sensitivity to vancomycin remained the same.The sensitivity of Gram-negative strains to ceftazidime and amikacin showed no significant change.As for the gram-positive peritonitis treated with cefradine as empirical treatment,compared with those in 2004-2009 group,in 2010-2015group the proportion of patients requiring to change their treatment regime was significantly higher,and the treatment course was longer.Conclusions A gradual decline is observed in the incidence of PDAP and the culture positive rate of pathogens improves.Peritonitis caused by coagulase-negative staphylococcus decreases overtime.The present empirical treatment protocols may need re-evaluation considering the decreased rate of the first generation cephalosporin sensitivity in recent years.

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.