This paper introduces the technical parameters,basic principle and investigation method of the multiparameter supervisor.The functions and implementation methods of its components are also presented.The supervisor can provide much physiological information of the patients to medical staffs.Thus,the level of medical supervision and analysis can be enhanced.The multiparameter supervision can be realized when the microcomputer system with PC-104construction is adopted to analyze the received signals and filter the interfering signals resulting from the random variations of frequency and amplitude.

Objective To investigate the prognosis of grommet insertions for osecretory otitis media in children and analyze the factors that may influence the results.Methods A retrospective review of 103 children (182 ears) with grommet insertions for osecretory otitis media from January 2011 to December 2011 was performed.They were divided into two groups(A and B) basing on the median age of 6 years old and observed their clinical manifestations,etiology and prognosis through two years' follow-up.The preoperative pure tone audiometry(PTA) hearing threshold,PTA in two weeks after surgery,the proportion of adenoid hypertro phy,the time of tube extrusion,the relapse of osecretory otitis media and repeat operation between two groups were compared.Results The difference of preoperative PTA and post operative PTA were not significant different between two groups(P＞0.05).But post operative PTA was lower than preoperative PTA(P＜0.05).The difference of otitis media recurrence was not significant different between two groups(P=0.088),but adenoid hypertrophy's proportion,tube extrusion's time and relapse were significant different(P＜0.05).Conclusion For school-age children with secretory otitis media need to extend the catheter time to reduce the probability of secondary catheterization.

Objective To find the best model parameters through Monte Carlo simulation of 6 MV flattening-filter-free (FFF) beams in TrueBeam accelerator, and establish the foundation for the further study of the clinical dosimetry on 6 MV FFF X-rays.Methods Using the BEAMnrc and DOSXYZnrc codes, the percentage depth dose (PDD) and the off-axis ratio (OAR) curves of field ranges from 4 cm ×4 cm to 40 cm × 40 cm were simulated for 6 MV FFF X-ray by adjusting the incident beam energy, radial intensity distribution and angular spread, respectively.The simulation results and measured data were compared, where the optimal Monte Carlo model input parameters were acquired.Results The simulation was most comparable to the measurement when the incident electron energy, full width at half maximum (FWHM) and the spread angle were set as 6.1 MeV, 0.75 mm and 0.9°, respectively.The deviation of 1 mm (position)/1％ (local dose) could be met by the PDD of all tested field sizes and by the OAR when the fields sizes were no larger than 30 cm ×30 cm.The OAR of 40 cm ×40 cm field sizes fulfilled criteria of 1 mm (position)/1.5％ (local dose).Conclusions Monte Carlo simulation agrees well with the measurement and the proposed model parameters, which can be used for further clinical dosimetry studies of 6 MV FFF X-rays.

Objective To compare the dosimetric difference between jaw tracking technique (JTT) and static jaw technique (SJT) in dynamic intensity-modulated radiotherapy (IMRT) for preoperative radiotherapy of rectal cancer patients.Methods Jaw tracking and static jaw were used to develope the intensity-modulated plans for 10 patients respectively.For all the patients,the dose to surrounding tissues was minimized as low as possible,the 95％ volume of the planning target volume (PTV) and planning gross target volume (PGTV) satisfy the prescribed dose.The doses of the planning target volumes,organs at risk and normal tissue were detected by dose-volume histogram.Two groups of treatment plan dose were verified by ionization chamber array 2D-Array 729 and OCTAVIUS (PTW) phantom.Results The treatment plans of two groups could satisfy the clinical requirements.There was no significant difference between the maximum and the mean dose of target.The volumes of jaw tracking dynamic intensity-modulated radiotherapy were lower,including the V5,V10,V20,V30,V40 (volumes receiving 5,10,20,30 and 40 Gy,respectively),mean dose(D) for body and V10,V20,V30,D for bilateral femoral head,bladder,and small intestine.There was significant difference for the results (t =-2.32-12.24,P ＜0.05).The verification results showed that the treatment plans were all passed the dosimetric verification.Conclusions Jaw tracking intensity-modulated radiotherapy and jaw fixed IMRT plan could achieve equal dose coverage in patients with rectal cancer,while jaw tracking techniques could reduce normal tissue dose and organs at risk dose.

Objective To clone the coding region and 3′non?coding region of calmodulin 2(CaM2)in guinea pig,to provide the genetic informa?tion for studying the gene function of Calmodulin 2. Methods Total RNA was extracted from heart tissue of guinea pig,the coding region and 3′non?coding region of CaM2 were amplified by RT?PCR and 3′?RACE PCR methods,and the recombinant plasmid was constructed by inserting cDNA of the coding region and 3′non?coding region of CaM2 into the cloning vector by genetic engineering technology followed by DNA sequencing and se?quence analysis. Results The cloned coding region of CaM2 was 450 bp,and the 3′non?coding region of CaM2 was 660 bp. The amino acid se?quences of the coding region of CaM2 was consistent with those of other CaM subtypes,and the 3′non?coding region of CaM2 had low homology with those of other subtypes. Conclusion The cloning of CaM2 coding region and 3′non?coding region in guinea pig was the foundation for further study on the gene function of CaM2 and its role in related diseases.

Medical immunology is an important frontier and bridge subject to connect basic medicine and clinical medicine, and its knowledge is abstract and difficult to understand. Micro-course is the new teaching resource with the education information. Its design, development and research have become a hot topic in network learning and mobile learning. In this article, it is elaborated that teaching design is the soul of the quality for micro-course and because micro class software is simple and easy to learn, it is a positive guarantee for the civilization and popularization of micro class, and besides, PPT is the important material in the micro-course. The article also explores the knowledge system of the fragmented micro lessons in series, and analyzes the potential value of micro teaching in the course teaching and personnel training.

ObjectiveUsing dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to evaluate the hemodynamic perfusion characteristics of bone marrow infiltration in patients with acute leukemia (AL). MethodsForty-seven patients with AL received coronal pelvic T1WI DCE-MRI with fast low angle shot (FLASH) sequence. Among them, 25 were initial onset untreated (IOU) patients, 22 were treated AL patients, including 14 with complete remission (CR) and 8 with non-remission ( NR). The hemodynamic perfusion parameters including maximum percentage of enhancement ( Emax ) and slope were determined based on enhancement-time curves ( ETCs ) of iliac and lumbar vertebra. The proportion of marrow myeloblasts was recorded.For all patients, quantitative perfusion parameters of bone marrow infiltration in ilium were compared with those in lumbar. The values of Emax and ES were compared among IOU,CR and NR patients.Correlations between perfusion parameters and histopathological results were assessed. ResultsIn all the 47 patients, the Emax values of bilateral iliac bone marrow ( 15.70 ± 7.06)were slightly higher than that of lumbar bone marrow ( 11. 28 ± 5.52 ), and the difference was statistically significant (P ＜0. 01 ).There was no significant difference in the slop value between bilateral iliac bone marrow (0. 82 ± 0. 12 ) and lumbar bone marrow (0. 80 ± 0. 09 ) ( P ＞ 0. 05 ). In the 25 untreated patients,the Emax and slop values were 17. 15 ± 5.75 and 0. 98 ± 0. 13, respectively; in the 14 CR patients, they were 8. 76 ±3.93 and 0. 26 ± 0. 04, respectively, and in the 8 NR patients, they were 21.62 ± 6. 50 and 1. 38 ± 0. 02, respectively. There was significant difference in the Emax and slop values among the three groups (P＜0. 05).Compared with IOU and NR patients, both the Emax and slop values decreased significantly in iliac bone marrow of AL patients with CR (P ＜ 0. 05 ). There was no significant difference between IOU and NR patients ( P ＞ 0. 05 ). A significant positive correlation was found between Emax value of iliac bone marrow and the proportion of marrow myeloblasts ( r ＝0. 501 ,P ＜0. 05 ). There was a negative correlation between slop value of iliac bone marrow and the proportion of marrow myeloblasts ( r ＝0. 235 ,P ＞0.05).ConclusionsDCE-MRI can beused for evaluating the hemedynamic characteristics of microcirculation of bone marrow infiltration in patients with AL, which can provide useful information in evaluating prognosis and monitoring therapeutic effect.

Objective To evaluate the secondary cancer risk to various organs due to radiation treatment for early left-sided breast cancer using 6 MV X-ray flattening filter free (FFF) and flattening filter (FF) modes.Methods Two techniques,6 MV FFF and 6 MV FF X-rays modes,were used to develop the two tangential fields d-IMRT plans for 20 early left-sided breast cancer patients respectively.For all the patients,the dose to surrounding tissues was minimized as low as possible,the 95％ volume of the planning target volume (PTV) and clinical target volume (CTV) was consistent with the prescribed dose.The beam parameters and the plan optimization parameters of FFF modes were in consonance with FF modes.The radiation doses and volumes of the planning target volumes,organs at risk and normal tissue were detected by dose-volume histogram.And then,the excess absolute risk(EAR) of contralateral breast,ipsilateral lung,contralateral lung,thyroid and liver were calculated using the radiotherapy-induced secondary primary cancer risks models.Results The treatment plans of two groups met the requirements of clinical.The FFF d-IMRT techniques resulted in a systematic reduction of the organ equivalent dose (OED) (t =2.18-9.72,P ＜ 0.05),and the EAR (t =2.11-9.99,P ＜ 0.05) of contralateral breast,ipsilateral lung,contralateral lung,thyroid and liver was compared to the FF IMRT techniques,especially for the contralateral breast.Conclusions Both FFF and FF d-IMRT plans can achieve comparable target dose coverage in patients with early left-sided breast cancer,while the FFF d-IMRT techniques could reduce the excess absolute risk of contralateral breast,ipsilateral lung,contralateral lung,thyroid and liver.These results are of clinical importance,especially for the early-stage patients with an overall good prognosis.

Objective: To summarize the characteristics of children diagnosed as cleft palate associated with middle ear cholesteatoma. Methods: There were five middle ear cholesteatoma cases who had previously received cleft palate repairment surgery. All of the patients were followed up for 17 to 47 months. Median follow-up time was 31 months. Results: There were three males and two females with three to eleven years old , and the average of age was seven years and ten months. The time of cleft palate repairment surgery was from six months to four years, and the average age was one year and nine months. No history of grommet insertion. Three cases were unilateral choleateatoma (right ear in two cases and left ear in one case, of which two cases of contralateral ear with secretory otitis media) and two cases were bilateral choleateatoma. Five cases(seven ears) received surgeries. Radical mastoidectomy + canal wall down tympanoplasty were performed in three ears, in which we found stapes disappeared. Radical mastoidectomy + canal wall up tympanoplasty were performed in four ears, in which we found intact foot plate, with recurrence occurred in one case nine months after the first surgery. No recurrence occurred after the second canal wall down tympanoplasty. The postoperative average hearing thresholds of air conduction were improved in different degrees. Conclusions There may be a relationship between cleft palate associated with middle ear cholesteatoma and no grommet insertion history. The incidence of bilateral cases is relatively high, and otitis media with effusion may occur because of poor Eustachian tube function in the unilateral cases. Choice of surgical methods should be decided basing on combination of decreasing the recrudescence and improving the hearing.

  Objective  To discuss the significance of genetic diagnosis of children with syndromic hearing loss by using whole-exome sequencing.  Methods  The clinical data of 34 children with sensorineural hearing loss were collected and the whole exons of genome of the children and their parents were sequenced and analyzed.  Results  Genetic causative gene and mutations have been identified in 19 children, including 4 genes (HARS2, USH2A, GATA3, MITF) related to rare syndromic hearing loss. Fifteen children were diagnosed with non-syndromic hearing loss related gene, including 8 cases with GJB2 mutation, 5 cases with SLC26A4 mutation and 2 cases with MYO15A mutation. Mutations of c.435_437del(p.K147del) and c.1403G > C (p.G468A) in gene HARS2, c.11389+1del in gene USH2A, c.1327delA(p.M443Wfs*33) in gene GATA3, c.627C > A(p.C209X) in gene MITF and c.8033_8057delinsG(p.N2678_D2686delinsS) in gene MYO15A were first reported.  Conclusions  Whole-exome sequencing helps the accurate diagnosis of causes of hearing loss, especially for the rare syndromic hearing loss with atypical clinical manifestations. Information from genetic testing may highlight further recommended exams of structure and functions of related organs.