Objective To compare the dosimetric difference of RapidArc and fixed gantry IMRT for liver carcinoma.Methods The CT data of 10 liver cancer patients were used to design 3 groups of treatment plan:IMRT plan,single arc RapidArc plan(RA1) ,and dual arc RapidArc plan(RA2).The planning target volume (PTV) dosimetric distrubition,the organs at risk (OAR) dose,the normal tissue dose,mornitor units(MU) and treatment time were compared.Results The maximum dose of PTV in RA1 and RA2 plans were lower than that of IMRT(Z = -2.090,-2.666,P ＜ 0.05).RapidArc groups had an improved 90% prescription dose conformity index than IMRT(Z = -2.805,-2.809 ,P ＜ 0.05).For organs at risk,RapidArc group plan had a significantly lower dose in V40 of stomach and small bowel than I MRT plan,but higher in mean dose of left kidney (Z = -1.988,-2.191,P ＜ 0.05).The values of V5,V10 and V15 of healthy tissue in RapidArc plan groups were higher than those in IMRT plan,while the values of V20 ,V25 and V30 of healthy tissue in RapidArc plan groups were lower than those in IMRT plan.The number of computed MU/fraction of Rapid Arc plan was 40% or 46% of IMRT plan and the treatment time was 30% and 40% of IMRT.Conclusion RapidArc showed improvements in conformity index and healthy tissue sparing with uncompromised target coverage.RapidArc could lead to the less MU and shorter delivery time compared to IMRT.

Objective To evaluate the efficacy in treatment with transurethral electrocision for prostatic cyst.Methods A total clinical documents of 15 cases prostatic cyst treated with transurethral electrocision were analyzed retrospectively.All the cases were diagnosed confirmly by ultrasonography and CT,all the cysts closed to the prostatic urethra or intrude urinary bladder and all the patients underwent transurethral electrocision.Results All operations were performed successfully with operative time of 18-60 (36 ± 13) min.No blood transfusion during and after the operation and postoperative hospital stay was (5.2 ± 2.6) d.All the patients had been followed up for 6-24 months,the clinic symptom disappeared and no complications happened.Three months after the operation,IPSS decreased from (27.2 ±5.6) scores to (7.5 ± 1.6) scores and QOL decreased from (4.5 ± 1.1 ) scores to ( 1.6 ± 0.6) scores (P＜ 0.01 ),respectively.Qmax increased from (6.8 ±2.3) ml/s to (22.4 ±4.8) ml/s (P ＜0.01).Conclusion Transurethral electrocision is an effective therapeutic measure of prostatic cyst close to the prostatic urethra or intrude urinary bladder without so many complications.

Objective To compare the dosimetric differences of target volume and organ at risk between intensity-modulated arc therapy (IMAT) and simultaneously integrated boost intensity-modulated radiotherapy (SIB-IMRT) in nasopharyngeal carcinoma. Methods IMAT and SIB-IMRT treatment plans of 10 nasopharyngeal carcinoma cases were generated by Varian Eclipse ver8. 6 treatment planning system. The dosimetric parameters of target volume and organ at risk (OAR), the monitor units (MU) and treatment time were compared between IMAT and SIB-IMRT treatment plan. Results The conformal index ( CI ) of PTV, PTV1, PTV2 of IMAT and SIB-IMRT were 0. 71 and 0. 75 ( Z = - 2. 32, P ＜ 0. 05 ), 0. 54 and 0. 59 (Z= -2.56,P＜0.05), 0.71 and 0.78(Z= -2.52,P＜0.05), respectively. the homogenous index (HI) of PTV, PTV1, PTV2 of IMAT and SIB-IMRT were 10.5 and 11.2(Z= -0. 84,P＞0.05),13. 1 and 17. 1(Z= -1.68,P＞0.05) and 14. 1 and 13.3(Z= -1. 01,P＞0.05) respectively;the brain-stem mean does were 3512. 8 cGy ± 406. 2 cGy and 3384. 3 cGy ± 361.3 cGy ( Z= - 1.82, P ＞ 0. 05 ); the brain-stem maximum dose were 5528. 1cGy ± 192. 9 cGy and 5727. 5 cGy ± 356. 3 cGy ( Z = - 1.12, P ＞ 0. 05 ); the maximum dose of spinal-cord were were 4186. 1cGy ± 88.7 cGy and 4390. 2 cGy ± 74. 9 cGy ( Z =-2. 38 ,P ＜ 0. 05 ). There were no significant differences between parotid dose and normal tissue ( P ＞0. 05. ) MU were 606 ± 96 and 1308 ± 213 for IMAT and SIB-IMRT ( Z= - 2. 52, P ＜ 0. 05 ). Conclusions The IMAT plan showed a better conformal index than SIB-IMRT plan, with the same dosimetric parameters of the target volume and OAR. The IMAT plan could reduce normal tissues dose, monitor units and treatment time in the treatment of nasopharyngeal carcinoma.

Objective To evaluate the performace of fixed field Intensity modulated radiation therapy (IMRT) and RapidArc in the radiotherapy for multiple intracranial metastases.Methods The clinical data of 10 patients with multiple intracranial metastases,8 male and 2 female,aged 65-73,were used to design 3 plans:fixed field IMRT,RapidArc with single Arc (RA1),and RapidArc with double Arc (Arc 2).Dose-volume-histogram analysis was used to compare dose results,monitor unit,and delivery time.Results All 3 plans met the clinical requirements.The best target conformity and homogeneity were observed in the RA2 plan (Z = -2.803,- 2.904,P ＜ 0.05) and there were no statistical differences between the IMRT plan and RA1 plan.The maximum doses to the lens,eyes,and brainstem of the two RapidArc plans were all significantly lower than those of the IMRT plan(Z = -2.803--2.191 ,P ＜0.05),and the maximum dose to the optic nerves of the RA2 plan was significantly lower than that of the IMRT plan (Z = -2.293,-2.701 ,P ＜0.05).Compared with the IMRT plan,the average monitor units of the RA1 and RA2 plans were reduced by 29% and 24%,respectively,and the delivery time of these plans were significantly shorter by 84% and 69%,respectively.Conclusions Compared to the IMRT plan,RapidArc plans with single or double Arcs show similar or better effects in the target dose distribution,reduction of irradiation doses on organs at risk and,moreover,significant decrease of the monitor units and delivery time.

Objective To compare and analyze the characteristics of intensity-modulated arc therapy (IMAT) versus fixed-gantry intensity-modulated radiotherapy (IMRT) in the treatment of cervical esophageal cancer.Methods Ten patients treated in our radiotherapy center were selected for this study.Based on the identical CT and planning target volume (PTV), two IMAT plans were generated with Eclipse ver8.6 planning system.IMAT1 consisting of a single 359.8° rotation, and IMAT2 consisting of two coplanar 359.8° rotations.PTV were prescribed to 60 Gy in 30 fractions.Planning objectives for PTV,corresponding with the IMRT plans, were V98 larger than 97% and V110 no more than 15%.The maximum dose of spinal-cord was constrained below 45 Gy.One-way ANOVA were applied to dose-volume values for PTV and OAR from DVH.Results There were no significant differences between IMRT and IMAT in PTV D98, V98, CI or total-lung V5, V10, V30, V40, V50 and mean lung dose (all P > 0.05).However, the differences were significant in terms of D2, V110 and HI of PTV, V20 of the total-lung (all P<0.05).On the MU,IMRT = 1174.8 MU,IMAT1 =709.7 MU,and IMAT2 =803.8 MU (F =39.25,P =0.000).On the treatment time,IMRT= 14.9 min,IMAT1 = 1.9 min, and IMAT2 =2.66 min (F=45.14,P=0.000).Conclusions IMAT is equal to IMRT in dosimetric evaluation.Due to much less MU and delivery time,IMAT is an ideal technique in treating patients by reducing the uncomfortable influences which could effect the treatment.However, IMAT1 is slightly inferior to IMAT2.

Objective To compare the dosimetric difference in forward intensity modulation radiotherapy (fIMRT)and inverse IMRT(iIMRT)planning for breast cancer.Methods Six patients received radiotherapy alone after left breast-conserving surgery were selected.For each patient,two treatment phns(flMRT and iIMRT)were designed with Pinnacle3 7.4f.In each plan,the volume of PIT received prescription dose was not less than 95 %.The dosimetrie parameters were assessed with dose volume histograms in planning target volume (PIT)and organ of around risk(OAR).Results Of flMRT and ilMRT plans,the PTV average canformal indexwere(0.67±0.06)and(0.66±0.06)(t = 2.423,P ＞ 0.05),average homogeneity index were (28.2±6.0)% and(26.1±6.8)%(t = 2.164,P ＞ 0.05);the volume of left lung received 20 Gy(V20)were(18.7±3.3)% and(17.0±2.8)%(t =5.087,P<0.05),and V30 of left lung were(15.5±3.0)%and(14.0±2.6)%(t =7.272,P<0.05);V30 of heart were(4.1±3.1)% and(3.5±2.5)%(t=1.916,P ＞ 0.05);the total monitor units were(262±5)MU and(308±14)MU(t = 7.515,P < 0.05).Conclusions There were no significant differences of CI,HI,and V30 of heart between flMRT and iIMRT.Because of fewer MUs,fIMRT plan could reduce the machine abrasion and treatment time,but V30 and V30 of left lung are higher significantly than iIMRT plan.

Objective To understand the status of service contract signing conducted by primary medical and health institutions.Methods A questionnaire survey and in-depth interview methods were used to study the service contract signing at primary health care institutions.Results The contract signing rate of the institutions surveyed was 1 9.1%,and valid contract signing rate was 76%.Senior people above 65 years old accounted for 33.5% of those signers,while hypertension patients accounted for 1 9.5% and diabetes patients for 10.6%.Interviews to the general practitioners team at the primary health institutions found that main factors affecting residents′ intention to sign were drug availability, attraction for signing the services,treatment habits among others.Interviews to the staff the primary health institutions found that contracted services are facing such difficulties as medical staff shortage,lack of motivation,lack of competence among others.Interviews to leaders of the primary health institutions found that the lack of publicity and support of medical insurance also has great influence to service contract signing.Conclusions The enthusiasm of general practitioners and residents to sign up for the service remains to be improved.

Objective:To investigate the effects of sign-contract services on hypertension patient disease control and the satisfaction of medical staff. Methods:a face-to-face questionnaire survey was conducted among hypertension patients selected from 20 primary health centers in 10 provinces in China. Results:This paper collected 1 ,881 valid questionnaires, and the average age of the population was 65. 72 ± 10. 88. Respondents that received sign-contract services accounted for 53. 88%, and there was no difference between patients who signed the service contract and who did not in terms of demographics. In self-reporting of blood pressure controls, respondents who signed the service contract, aged 40~50 years old, enjoyed the free medical care, preferred to seek medical services from primary a-gencies ( i. e. community health centers and township hospitals) for minor illnesses, controlled their blood pressure better ( P<0. 05 ) . Respondents enjoyed the civil resident medical insurance, preferred to seek medical care from community health centers for minor illnesses and signed the service contract were more likely to be satisfied with their medical practitioner (P<0. 05). After adjusting for age, gender, education level, medical insurance style, patient willingness to seek medical care for minor illnesses, signing service contracts was found to be an independent factor both associated with blood pressure self-control and attitudes towards medical service providers, with the odds ratio of 3. 007 (95%CI:2. 572 -3. 517) and 1. 814 (95%CI: 1. 563 -2. 105) respectively. Conclusion: Contracts are correlated with blood pressure control and satisfaction toward medical practitioners, which means that patients who signed the service contract control their blood pressure better and are more satisfied with their medical deliverers.

OBJECTIVE:To provide reference for further promoting the clinical application of chronopharmacology and rational drug use.METHODS:The self-designed questionnairea was used to conduct on-site investigation among participants from 40 hospitals in Anhui province by dint of a meeting.The survey data were analyzed statistically.RESULTS:Totally 170 questionnaires were distributed,and 166 were retrieved,the total response rate was 97.65％.93.37％ of the interviewed pharmacists were aware of the circadian rhythms,and 87.35％ were aware of the circadian rhythms of more than two kinds;interviewed pharmacists expressed better awareness of indicators like gastric acid secretion (75.30％),blood pressure (67.47％) and growth hormone (66.87％) etc.while their awareness of other diseases like anaphylactic rhinitis (66.87％),gastric ulcer (50.60％) and migraine (50.00％) remained to improve.All the interviewed pharmacists recognized the better therapeutic efficacy (84.34％) and lower side effect (81.33％) of chronopharmacology-referred medication;chronopharmacology characteristics of glucocorticoid drugs were best known (34.34％),followed by antihypertensive drugs (25.30％).CONCLUSIONS:Pharmacists in Anhui province have certain knowledge of chronopharmacology such as biological rhythms,biological process or indicators,biological rhythms of disease and advantage of chronopharmacology-referred medication.It indicates that there has been a foundation for popularizing the concept of chronopharmacology in clinical medication in China;but not often contacted physiological processes or indexes,the understanding of biological rhythm of uncommon diseases are still insufficient,and the understanding of chronopharmacology characteristics of various drugs are far from ideal.

Objective To explore the efficacy of middle and high (mid-high) flow intracranial-external vascular bypass in treatment of complex intracranial aneurysms and selection of grafts. Methods The clinical data of 79 patients with complicated intracranial aneurysms treated by mid-high flow extracranial-intracranial bypass in our hospital from August 2010 to October 2017 were collected retrospectively. The grafts were radial artery (n=21), saphenous vein of the calf segment (n=29) or thigh saphenous vein segment (n=29). The efficacy was determined based on Glasgow outcome scale (GOS) scores at discharge and modified Rankin scale (mRS) scores at follow-up, and the differences of occlusion in different types of grafts were analyzed. Results CTA showed patency of the grafts in all patients one d after surgery. There were 6 patients having vascular occlusion: 2 patients (the grafts at saphenous vein of the calf segment ) were occluded 3 and 4 d after surgery, without symptom; 2 patients (the grafts at the radial artery), with decreased limb muscle strength, were occluded 5 and 25 d after procedure; 2 patients ( the grafts at the saphenous veins of the calf segment) were occluded 6 months after procedure without any symptom. There were 4 patients developed cerebral ischemia after operation: one had cerebral infarction and three had vasospasm. GOS scores at discharge and mRS scores at follow-up showed that 78 patients had improved symptoms and good prognosis; one patient showed no improvement in symptoms and plant survival. Conclusion Mid-high flow extracranial-intracranial bypass for treatment of complex intracranial aneurysms is effective; the graft should be individually selected based on preoperative assessment results.