The design of a conventional radiotherapy plan is a time-consuming and labor-intensive process, and relevant parameters need to be continuously adjusted in the plan optimization to identify the optimal plan. In addition, experience differences between planners, time invested in plan design, and institutional standards all affect the quality of the plan, which in turn influences clinical outcomes and patient prognosis. In recent years, automatic planning has developed rapidly, which can improve the efficiency of planning design while ensuring the quality of the plan. At present, there are several methods dedicated to the automation of radiotherapy planning design, such as the Rapid Plan and Auto-Planning functions in Eclipse and Pinnacle commercial treatment planning systems, and there are also studies applying artificial intelligence technology in dose prediction to achieve automatic planning. In this article, the research progress on automatic radiotherapy planning was reviewed, and the realization principles, clinical efficacy and existing problems of various automatic planning methods were illustrated.

Irritable bowel syndrome( IBS)is a commonly seen chronic functional bowel disease,the prevalence showed a rising trend in recent year in China. At present,the etiology and pathogenesis of IBS have not yet been fully elucidated,and may be related to intestinal gas. Intestinal gas is usually composed of 59% N2 ,21% H2 ,9% CO2 ,7%methane(CH4 )and 4% O2 ,in which H2 and CH4 are produced only by intestinal bacteria metabolism. IBS patients usually manifested as having abdominal distension and symptoms of flatulence,suggesting the occurrence of accumulation of intestinal gas. In recent years,the relationship between symptoms of IBS and intestinal gas has attracted much attention. This article reviewed the progress in study on symptoms of IBS and intestinal gas.

Objective To observe the anesthesia related effect of dexmedetomidine conscious sedation on Laryngeal mask airway general anesthesia in Parkinson patients with deep brain electric stimulus implantation.Methods Forty patients (72 males, 8 females, aged 18-75 years, ASA physical status Ⅰ or Ⅱ) of Parkinson disease with selective operated bilateral subthalamic nucleus deep brain electric stimulus implantation were selected and randomly divided into dexmedetomidine group (group D) and contrast group (group C), 20 cases in each group.The operation divided into two stages: in the first stage, the electrode was put under the local anesthesia, CT examination proof of electrode placement satisfaction was the end of the first stage.The second stage needed to bury the pulse generator under of the chest skin under general anesthesia.For group D, dexmedetomidine 0.5 μg/kg was pumped venously within 15 min after entering the operating room, the speed of 0.1-0.3 μg·kg-1·h-1 was kept subsequently until the end of the first period.For group C, the same dosage of normal saline was pumped.The times of micro-electrode interference, tremor relief were recorded.Ramsay scores of two groups of patients were recorded at the entry of operating room (T0), partial infiltration anesthesia (T1), unilateral electrode implantation (T2), contralateral electrode implantation (T3), the end of the first period (T4);the time needed to vanish consciousness, implant laryngeal mask airway, recover the spontaneous breathing and extubation were recorded;the propofol, remifentanil dosage from the beginning of general anesthesia induction to the end of the surgery were recorded.Results The micro-electrode was intervened and tremble was relieved in both two groups.Compared with group C, the ramsay scores of T1-T4 were obviously increased in group D (P<0.05), the time needed to vanish consciousness, implant laryngeal mask airway, recover the autonomous respiration, extubation were significantly shortened in group D (P<0.05), the dosage of propofol, remifentanil from the beginning of the general anesthesia starts to the end of the surgery were significantly reduced in group D (P<0.05).Conclusion Dexmedetomidine provided the excellent sedation to the first period of Parkinson patients with deep brain electric stimulus implantation;it can shorten the time of the anesthesia induction and awakening time, as well as decreases propofol and remifentanil dosage.

BACKGROUND: Full-thickness skin graft was a base for bum and plastic surgery, while uniform pressure and regional brake were key factors to ensure skin graft survival and avoid from necrosis. Traditionally, package and pressurized fixation were performed after skin transplantation; however, it induced residual dead space and unclear skin graft fixation, as well as suturing scar.OBJECTIVE: To study the effect of vacuum sealing drainage applied to full-thickness skin graft.METHODS: A total of 8 New Zealand rabbits were used to establish full-thickness skin graft models in three regions of bilateral spine. Vacuum sealing drainage, traditional pressurized suture and common wrapping were performed in the three regions, respectively. The skin graft survival was observed, and survival rate was calculated at 14 and 21 days. On the 3rd, 7th, and 14th days, samples were selected from skin graft and stained. The morphology was observed under light microscope and transmission electron microscope. The time to remove the drain vessel was that when the fluid was not increased or the fluid was clear.RESULTS AND CONCLUSION: The survival rate of vacuum sealing drainage group was significantly higher than that in other two group (P < 0.05), while the survival rate of traditional pressurized suture group was significantly higher than that in the common wrapping group (P< 0.05). Morphology examination demonstrated that regional cuticular layer was necrotic in the vacuum sealing drainage group after early skin transplantation, while inflammatory cell infiltration, fibroblast degeneration, and mitochondrial swelling were also observed. At later skin transplantation, fibroblast and basal cell were proliferated, and function of mitochondria and plasmid was active. This suggested that vacuum sealing drainage promoted survival rate of skin graft.

Gastrointestinal bleeding is a common complication of gastrointestinal diseases and gastrointestinal surgery, which may lead to hemorrhagic shock or cause death if not treated properly and promptly.Currently, endoscopic treatment for gastrointestinal bleeding includes clip closure, endoscopical injection of saline/adrenaline, argon plasma coagulation (APC), electrocoagulation and heater probe coagulation etc..Endoscopic clip closure mainly includes traditional closure through-the-scope clip (TTSC) and more novel closure over-the-scope clip (OTSC).This article reviewed the use of OTSC in the treatment of gastrointestinal bleeding.

BACKGROUND:Methylprednisolone has been used for the treatment of acute spinal cord injury but there is a dispute about the efficacy and safety of methylprednisolon. OBJECTIVE:To evaluate the efficacy and safety of methylprednisolon based on system review. METHODS:PubMed database, EMBASE database, Cochrane Library, ISI Web of knowledge, CBM database, VIP database, CNKI database and Wanfang database were searched from their start year up to December 2014 for relevant randomized clinical trials on the treatment of acute spinal cord injury with methylprednisolon. RESULTS AND CONCLUSION:Twelve randomized clinical trials with 642 acute spinal cord injury patients were included. The results of the Meta analysis showed: methylprednisolone+conventional therapy was better to improve American Spinal Injury Association (ASIA) motor function score, ASIA touch sensation score, ASIA pinprick sensation score and the overal Frankel score than the conventional therapy alone (control group) with statistical significance (P < 0.05). In the aspect of safety, the methylprednisolone group had higher death ratio, digestive tract reaction ratio and urinary infection ratio than the control group but with no statistical significance. The gastrointestinal bleeding ratio and lung infection ratio was significantly higher in the methylprednisolone group than the control group (P < 0.05). We conclude that methylprednisolone has protective effect on acute spinal cord injury, but the main side effects are gastrointestinal bleeding and lung infection. There is a need for high-quality randomized controled trials to prove the efficiency and safety of methylprednisolone.

Objective To assess the clinical value of 131I-metaiodobenzylguanidine (MIBG) scintigraphy in pheochromocytoma. Methods A total of 430 patients with clinically suspected pheochromocytoma underwent 131I-MIBG whole body scintigraphy, 326 among them underwent B-ultrasound, 400 for CT and 77 for MR examination respectively. While 178 among them were diagnosed with pathology and the others were diagnosed clinically. Results Of all the patients, 108 were diagnosed pheochromocytoma, including 89 131I-MIBG scan positive and 19 negative. The sensitivity, specificity and accuracy of 131I-MIBG were 82.41%, 100% and 95.70%, respectively. 131I-MIBG scan detected 90.00% of unilateral adrenal, 45.45% of bilateral adrenal, 85.71% of ectopic and 66.67% of malignant lesions, respectively. The proportion of patients with positive 131I-MIBG scan increased from 20.69% in all patients to 35.15% in patients with clinical symptoms and positive conventional imaging (at least one of B-ultrasonography, CT or MR was positive) and 64.58% in those with clinical symptoms, positive conventional imaging, and elevated 24 h urinary catacholamines. In 59 patients with adrenal incidentaloma, 8 were scan-positive and all had confirmed pheochromocytoma, while 2 of scan-negative patients also had confirmed pheochromocytoma. Conclusion 131I-MIBG scintigraphy is the first choice for the diagnosis of both adrenal and extra-adrenal pheochromocytoma. However, it is inappropriate to take this method as the initial screening approach.

Objective To improve the recognition of aggressive natural killer-cell leukemia(ANKL)complicating muhiple organ failure(MOF).Methods A Fare case of ANKL was reported,and the related literatures were reviewed. Results One case of ANKL was diagnosed by bone marrow morphology and immunophenotypes of CD2,CD16,CD56,who developed multiple organ failure involving in liver,kidney,heart,lung,severe metabolic acidosis,tumour lysis syndrome and disseminated intravascular coagulation(DIC)in course of the disease and chemotherapy.VP regimen and symptomatic treatment were performed,and the disease could be stable shortly but died of the failure of lung and heart soon. Conclusion ANKL has a fulminant clinical course and diffuse infihration of tumor cells resulted in multiple organ failure with poor response to treatment and unfavorable prognosis.

Objectives To investigate the mechanism of integron mediated resistance and multidrug-resistance in P.aeruginosa.Methods The variable region of integron was amplified by integron PCR.Restriction fragment length polymorphism(RFLP)and DNA sequencing were used to investigate the resistance genes in the variable region of integron.Results Of the 98 strains 35(35.7%)were the variable region positive,and size of the amplicons ranged from 1.0 kb to 4.0 kb.A total of 6 different cassette arrays were detected,including genes coding resistance to aminoglycosides,?-lactam compounds and sulfanilamides.Of the 5 cassette arrays 3 were novel,including aadA6-orfD,aadB-blaP1 and aadB-aac6-Ⅱ-blaCARB-8,and the Genbank numbers were DQ 091179,DQ 141316 and DQ 288251 respectively.Conclusions Integron mediates the resistance and multidrug resistance in P.aeruginosa.The majority of the genes located in integrons are those coding resistance to aminoglycosides.Three strains of class I integron with novel cassette arrays are reported.