Target volume definition is one of the important factors in precise radiotherapy of esophageal carcinoma.However,there is considerable controversy about delineation of esophageal carcinoma clinical target volume (CTV),and no consistent standard.Recent researches show that pathological characteristics,imaging methods and lymph node metastasis pattern may have guiding functions for CTV delineation.Novel delineation technique such as individual design has been a research hotspot.

Environmental Monitoring ; methods ; Noise, Occupational ; statistics & numerical data

Pancreatic encephalopathy(PE)is one of the severe complications in acute pancreati-tis,which is characterized by a group of neurological signs and symptoms. Itˊs very difficult to have an early diagnosis,while the morality of PE is very high and the prognosis is very poor. Eliminating causes of pan-creatic encephalopathy,early diagnosis and combined therapy are the keys to achieve good curative effects. This paper reviewed the recent progress in the main mechanisms,clinical manifestations,diagnosis and therapy of PE.

Objective To observe the clinical efficacy of warm needling plus Chinese medicinal fumigation in treating rheumatoid arthritis (RA) due to cold-dampness.Method Fifty-three patients with RA due to cold-dampness were randomized into a treatment group of 27 cases and a control group of 26 cases. The control group was intervened by conventional medication, while the treatment group was by warm needling plus Chinese medicinal fumigation in addition to the medication used in the control group. The Visual Analogue Scale (VAS), joint symptom parameters, Score of Quantified Syndrome of Traditional Chinese Medicine, Health Assessment Questionnaire (HAQ), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were observed before and after treatment, and the effective rate was evaluated by using the criteria stipulated by the American College of Rheumatology (ACR20).Result The VAS scores, joint symptom parameters, scores of quantified syndrome of traditional Chinese medicine, and HAQ were significantly changed after treatment in both groups (P<0.05). After treatment, the VAS score, joint swelling score, painful joint count, morning stiff duration, Score of Quantified Syndrome of Traditional Chinese Medicine, and HAQ in the treatment group were significantly different from that in the control group (P<0.05). The ESR and CRP levels were markedly changed after treatment in both groups (P<0.05). After treatment, the ESR and CRP levels in the treatment group were significantly different from that in the control group (P<0.05). The total effective rate was 74.1% in the treatment group versus 57.7% in the control group, and the difference was statistically significant (P<0.05).Conclusion Warm needling plus Chinese medicinal fumigation is an effective method in treating RA due to cold-dampness.

Twenty-six total intravenous anesthesia was performed in 23 ASAⅡorⅢpatients with various advanced malignancies undergoing whole body hyperthermia (WBH). Their age ranged from 32 to 67 yrs and body weight between 42 and 77 kg. The patients had no hypertension, coronary artery disease or diabetes mellitus. Anesthesia was induced with midazolam 5-10 mg, fentanyl 0.1 mg, propofol 1.5-2.5 mg?kg-1 and vecuronium 0.12 mg?kg-1 and maintained withⅣinfusion of midazolam (0.08-0.16 mg?kg-1?h-1), remifentanil (0.05-0.15?g?kg-1?h-1) and vecuronium (0.08-0.15 mg?kg-1?h-1). The patients were mechanically ventilated (VT = 8-12 ml?kg-1, RR= 10-18 bpm, FiO2 = 1.0) after tracheal intubation. PETCO2 was maintained at 35 mm Hg. ECG, MAP, HR, CVP, SpO2 , PETCO2 , peak airway pressure, VT, RR, minute ventilation (MV), urine output, core temperature (lower esophageal and naso-pharyngeal) and surface temperature were continuously monitored. Swan-Ganz catheter was placed in 15 patients. MPAP, PCWP and cardiac output (CO) were measured and Qs/Qt, cardiac index (CI) and stroke index (SI) were calculated. WBH was induced in an ultra-red radiation hyperthermic cabin (type ET-SpaceTM-1) and was divided into 3 phases:Ⅰwarming phase (lower esophageal temperature increased gradually to 41.8℃) ;Ⅱhyperthermic phase (lower esophageal temperature was maintained at 41.8℃for 1 h) andⅢcooling phase (core temperature was gradually decreased to 38.5℃without any cooling measures). Blood samples were taken from artery and Swan-Ganz catheter 15 min after induction of anesthesia (baseline), at 39℃, 40℃, 41℃and 41.8℃during warming phase, at the late hyperthermic phase and at 40℃and 38.5℃during cooling phase for blood gas analysis, determination of blood electrolytes and sugar. As the temperature was increasing, HR, CI, SI, CVP, MPAP, PCWP, Qs/Qt and peak airway pressure were gradually increased while MAP, PaO2 , pHa, BE and blood glucose and K+ were decreasing during warming phase (Ⅰ). These changes reached the peak levels at the late period of hyperthermic phase (Ⅱ) and then gradually returned to baseline during cooling phase (Ⅲ) . Vasoactive drugs and fluid infusion including crystalloid and colloid were needed to maintain hemodynamic stability in 69% patients. Acidosis had to be corrected in 54% patients. Severe hypotension and pulmonary edema occurred in 4 patients. Continuous hemodynamic monitoring, respiratory support, maintenance of circulatory stability and correction of acidosis and hypokalemia were the key factors in the management of patients during WBH.

0bjective To determine the effect of 2 therapies(early realignment versus delayed open urethroplasty)for posterior urethral injuries associated with pelvic fractures. Methods A sys-tematic review of all the relevant clinical trials was performed.Trials were identified from specialized trials register of Cochrane UGDP Group,the Coehrane library,additional electronic search(mainly MEDLINE、EMBSAE、CBM)and manual searching.Clinical trials comparing early realignment and delayed open urethroplasty of posterior urethral disruption associated with pelvic fractures were includ-ed.Statistics analysis was managed by using Review Manager 4.2. Results Ten clinical trials inclu-ding 470 patients were included.Meta-analysis indicated that odds ratio(OR)of the rate of urethral stricture was 0.27[95%confidence interval(95%CI)0.08,0.86,P=0.03].The OR of the percent-age of strictures needing urethroplasty was 0.25,95%CI 0.08,0.74,P=0.01. Conclusions Early realignment may provide better outcomes than delayed open urethroplasty after posterior urethral dis-ruption.It can decrease urethral stricture formation and the percentage of strictures needing urethro-plasty.But the results might be influenced by the bias of grouping,especially the severity of injuries.

Objective The stimulating factors and etiology of myocyte hypertrophy are not yet clear.We aim to investigate the mechanisms of bone morphogenetic protein 4 (BMP4)-induced H9C2 myocyte hypertrophy in rats by activating the extracellular signal regulating kinase ( ERK1/2) signaling pathway. Methods Rat H9C2 myocytes were cultured, the model of BMP4-induced H9C2 myocyte hypertrophy was established, and the cells were randomly di-vided into control A, BMP4 A, and angiotensinⅡ( AngⅡ) groups to be treated for 48 hours.The changes in the expression of ERK1/2 protein phosphorylation were observed at 0, 10, 30, 60, and 120 min after treated with BMP4 at the concentration of 50 μg/L and at 30 min after treated with BMP4 at 0, 10, 50, and 100 μg/L.The changes of the H9C2 myocytes were also observed after blocking the ERK1/2 signaling pathway.The cells were divided into control B, BMP4 B, BMP4+PD98059, and PD98059 groups to be cultured with 50μg/L BMP4 for another 48 hours after 30 min blockage with PD98059 at 50 ×10 -6 mol/L.The size and area of the cells were measured by inverted microscopy and image J Software, their total protein content detected by BCA, and the expressions of p-ERK1/2 and brain natriuretic peptide ( BNP) determined by Western blot. Results Compared with control A, the BMP4 A, and AngⅡ groups showed markedly larger cell areas ([649.74 ±2.03] vs [744.85 ±1.31] and [748.39 ±1.54] μm2), higher protein contents ([243.18 ±3.69] vs [340.09 ±2.14] and [347.43 ± 3.30] pg/cell), and higher expressions of the BNP protein ([0.72 ±0.44] vs [0.96 ±0.55] and [1.07 ±0.55]/GAPDH), with statistically significant differences between any two groups (P>0.05).After BMP4 intervention, the expression of p-ERK1/2 manifes-ted a time-dependent trend of first going up and then coming down, reaching the peak at 30 min, with the ERK1/2 protein phosphoryl-ation significantly higher at 30 min than at 10 min (P>0.05), especially than at 0, 60, and 120 min (P>0.01).The level of p-ERK1/2 protein phosphorylation in the mytocytes was elevated with the increased concentration of BMP4, remarkably higher at 50μg/L than at 0 and 10μg/L, but lower than at 100μg/L ( P>0.01) .The cell area, protein content, and BNP protein expression of the H9C2 myocytes were significantly lower in the BMP4+PD98059 group ([650.49 ±1.28] μm2, [244.06 ±3.48] pg/cell, and [0.55 ±0.15]/GAPDH) than in the BMP4 B group ([746.04 ±1.45] μm2, [343.57 ±4.11] pg/cell, and [0.79 ±0.55]/GAPDH) (P>0.01). Conclusion BMP4 may induce hypertrophy of rat H9C2 myocytes by activating the ERK1/2 signaling path-way.Early blocking of ERK1/2 activation may contribute to the management of myocardial hypertrophy.

Objective To explore the effects of vasoactive intestinal peptide (VIP)on the ratio of CD4+CD25+Treg/CD4+T cell and the expression of TGF-β1 in experimental autoimmune encephalomyelitis (EAE)rats. Methods We randomly divided 60 healthy female Wistar rats into normal control group,EAE control group,VIP low-dose group and VIP high-dose group.We used myelin basic protein (MBP)+ complete adjuvant (CFA)to establish EAE model. Since the day of model construction, the low- and high-dose VIP groups received intraperitoneal injection of 4 nmol/kg (0.2 mL)and 16 nmol/kg (0.8 mL)of VIP every other day,respectively;normal control group and EAE group received injection of saline of 0.8 mL for 10 days in a row.We recorded the peak of neurological dysfunction score (NDS)changes in the rats,observed the pathological changes and GFAP+astrocyte activation in the brain at the morbidity peak of rats with HE staining,and detected the ratio of CD4+CD25+Treg/CD4+T in the spleen with FACS and TGF-β1 cytokine level in brain tissue with ELISA.Results The peak nerve dysfunction score was decreased in each VIP dose group.In normal control group,there were decreased inflammatory cell infiltration and decreased number of active astrocytes in the brain tissue.The degree of infiltration of inflammatory cells and astrocyte activation in VIP control groups were significantly lower than those in EAE group.The CD4+CD25+Treg/CD4+T cell ratio of the spleen tissue in each dose VIP treated group rats was higher than that in EAE control group.The cytokine level of TGF-β1 in the brain tissue increased in each VIP dose group in the dose-dependent manner.Conclusion Through up-regulating the ratio of CD4+CD25+Treg/CD4+T cell in the spleen tissue,increasing TGF-β1 content in brain tissue,and inhibiting the infiltration of inflammatory cells and the astrocyte activation,VIP plays an important role in prevention and control of EAE.

Objective:To evaluate the effects of different denture cleansers on the physical and mechanical properties of heat-cured denture base resin.Methods:Heat-curing denture base resin samples were prepared and respectively immersed in Polident,Stera-dent,0.5% sodium hypochlorite solution and distilled water for 60 h.The flexural strength and elastic modulus were measured(n =10)using 3-point bending test in a universal testing machine.A surface analyzer was used to measure the surface roughness of each specimen(n =10).Results:There were no significant differences of flexural strength and elastic modulus among Polident,Steradent and distilled water(P >0.05).The 0.5% sodium hypochlorite treatment produced lower flexural strength and elastic modulus than the other cleaners(P <0.05).No statistical significance of roughness was found among the solutions(P >0.05).Conclusion:Both Poli-dent and Steradent don't affect the physical and mechanical properties of the heat-cured acrylic resin.0.5% sodium hypochlorite solu-tion doesn't affect the surface roughness,but decreases the flexural strength and elastic modulus of the resin.

The radiation techniques for lung cancer stereotactic body radiotherapy (SBRT) include intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT).Concerning the target conformity and dosimetric homogeneity index, HT and VMAT technologies are superior to IMRT.On the contrary, HT and VMAT technology can increase low dose area irradiated of lung.Comparing to other two technologies, VMAT can obviously shorten the treatment time.At present, there is no consensus how to choose individually optimized radiotherapy technology for different location and stages lung tumors.