It has been realized that the 4Rs (repair,repopulation,redistribution,and reoxygenation) would affect the result of cell irradiation,and thus radiation treatment.The 4Rs each occurs at different dose rates,usually very low dose rates.Depending on the dose rate used for treatment,the corresponding R should be included in the linear-quadratic equation (LQ) and biological effective dose (BED) calculation.For low dose rate brachytherapy(LDR) especially permanent implant,all the 4Rs should be included in LQ for BED calculation.The 4Rs,especially repair and repopulation,play a critical role in dose fractionation.Various dose fractionation schemes such as hyperfractionation and hypofractionation are determined in consideration of the 4Rs.Stereotactic radiation therapy uses hypofractionation with high fractional doses and combine with high accuracy target localization techniques to achieve high local control rates compared to conventional dose fractionation schemes.The 4Rs have been taken into account for LDR and permanent implant.Recently,LQ for permanent implant brachytherapy has been modified to include all the 4Rs for gynecological malignancy 131Cs permanent implants.Including the 4Rs in radiation therapy has significantly improved the effectiveness and efficiency of radiation therapy for cancer treatment.

High intensity focused ultrasound (HIFU)is a new technology of focal therapy for patients with hepatic carcinoma.Comparing with operation and other focal therapeutic methods (such as radiofrequency and transcatheter arterial chemoembolization) of liver cancer,HIFU is non-invasive,accurate,and definite in killing the tumor tissue with fewer complications.Thus,it is widely accepted in clinical settings and has a promising prospect.In this article,we review the mechanism and present situation of hepatic carcinoma therapy with HIFU and dicuss some clinical application and development in the future.

Objective To explore the effective prognostic factors of patients with multiple traumas. Method During January 2003 to March 2007, totally 324 patients with multiple traumas were treated in the emergency department of Renmin Hospital, Wuhan University. The relationship between prognosis and age, visiting time after injury, injury severity score (ISS) ,main wounded part and shock degree was analyzed. The data were tested using ehi-square test and logistic regression method. Results Seventy-eight patients died and 246 patients survived, the total mortality was 24.1%. Statistical differences existed in mortalities of patients with different visiting time (visiting hospital within 1 h,16.7%; visiting hospital beyond 1h, 37.4%),ISS (16≤ISS≤24, 5.7%; 25≤ISS≤40, 19.2%; IS8>40, 41.3%) and shock degree (non-shock, 11.8%; mild shock, 13.6%; moderate shock,27.7%; severe shock,46.9% ) ( P<0.01). There were no significant difference in mortalities among patients with different age (<18, 23.8% ; 18～38, 21.7% ; 38～58, 24.2% ;>58, 32.5% ) and with various main wounded part (head, 26.0%; neck, 25.3%; chest, 27.3%; abdomen, 24.1%; limbs, spine and pelvis,16.3%), P>0.05. Logistic regression study showed that mortality increased with postponed visiting time after injury, augment of ISS and aggravation of shock degree, with the exception that there was no differenoe in mortality of patients with between non-shock and mild shock. Conclusions Visiting time after injury, ISS and shock degree were valuable progrostic predictors for multiple traumas. It's vital to follow principle of damage controlled surgery and emphasis on the timeliness and integrity of medical rescue and control shock actively to reduce mortality of patients with multiple injuries.

Objective To evaluate clinical value of tumor biomarkers in ascitic fluid and serum in differentiating benign from malignant ascites and their correlation. Methods From July 2006 to July 2009,67 patients with ascites undergone abdominal paracentesis in Renmin Hospital of Wuhan University were enrolled in the study and divided into malignant and benign groups according to their etiology. Levels of tumor biomarkers in ascitic fluid and serum were determined and their correlation were analyzed. Diagnostic sensitivity and specificity of tumor markers were evaluated. Results There was statistically significant difference in levels of cancer antigen 199 (CA199) in serum and ascitic fluid between the malignant group and the benign one ( P ＜ 0. 01 ), and level of cancer embryonic antigen (CEA) significantly increased in ascitic fluid (P ＜ 0.05 ). Levels of CA199 and CEA in serum were significantly higher than those in ascetic fluid in the benign group (P ＜ 0. 01 and P ＜ 0. 05 ), and level of CA125 was significantly lower in serum than that in ascitic fluid (P ＜ 0. 01 ). Level of alpha-fetal protein (AFP) in serum significantly correlated with that in ascitic fluid in the benign group (r =-0. 992, P ＜0. 01 ). In the malignant group, levels of CA199, CEA and CA125 were significantly higher in ascitic fluid than those in serum (P ＜0.05 or P ＜0. 01 ). Levels of CA199 and CEA in serum significantly correlated with those in ascetic fluid in the malignant group (r =0. 746 and 0. 572, respectively, P ＜0. 01 ), and level of AFP in serum also correlated with that in ascetic fluid (r=0. 384, P ＜0. 05). Ratios of levels of CA199 and CEA in ascetic fluid to those in serum (F/S) were significantly higher in the malignant group than those in the benign group (P ＜0.05 or P ＜0.01). Use of combination of CA199, CEA and CA125 determinations showed a higher sensitivity and specificity in differential diagnosis for benign and malignant ascites (P ＜0.05). Conclusions Determinations of CA199 and CEA are beneficial for differentiating benign ascites from malignant one. Determinations of tumor biomarkers in serum can not fully replace those in ascetic fluid. Combined determinations of CA199, CEA and CA125 can increase their sensitivity and specificity in diagnosis for malignant ascites.

Objective To evaluate and compare the clinical applications of Disposcope (DS)en-doscope and GlideScope (GS)video laryngoscope in double-lumen endobronchial tube (DLT)intuba-tion of the patients with difficult airway.Methods Forty patients scheduled for elective thoracic sur-gery after failure to place the DLT with modified general laryngoscope 2 attempts were randomly dev-ided into 2 groups,20 cases in each group.Patients underwent DLT with DS (group DS)or GS (group GS)intubation after failure to intubation.The causes of the failure of intubation,the intuba-tion of the video laryngoscope,the time of intubation and the location of left double lumen tube were recorded.And the postoperative injury of oral mucosa,teeth and respiratory tract were observed. Results The causes of the difficulty for DLT intubation included:long,high arched palate,large epi-glottis,reduced jaw opening,protruding or loose incisors,over bite,reduced neck extension.The in-tubating achievement ratio was significantly higher in group DS than in group GS (P < 0.05 ).But there was no obvious difference between the two groups in the location success rate and intubation time.The postoperative incidence of tooth loss and oral mucosal injury was significantly higher in group GS than in group DS (P <0.05).Conclusion Both DS and GS were great helpful to intubation and location of DLT in the patients with difficult airway.But DS was more superior than that of GS in the difficult airway of reduced jaw opening,protruding or loose incisors,over bite and reduced neck extension.

Objective To research and compare the effectiveness distinction between applying exclusive salcatonin and combining salcatonin and Xianling Gubao to treat osteoporotic pain patients.Methods 84 cases of osteoporotic pain patients in our hospital from Feb.2013 to Feb.2014 were selected and divided into two groups.Patients in treatment group were received combination of salcatonin and Xianling Gubao treatment.Patients in control group received salcatonin treatment only.To apply VAS judge the pain degree of patients.The clinical performance and results were observed and recorded.The degree of satisfaction of patients was surveyed through questionnaire.Results The VAS of patients in treatment group was (2.17 ±1.02), while it was (4.26 ±1.37)in control group.There were 15 cases of excellent,and 23 cases of efficacious in treatment group and the total effective rate was 90.48%.There were 10 cases of excellent,and 19 cases of efficacious in control group and the total effective rate was 60.95%.The degree of satisfaction of patients in treatment group was 95.24%,while it was 71.43% in control group.Conclusion Combining salcatonin and Xianling Gubao has better clinical effect than applying exclusive salcatonin in treatment of patients with osteoporotic pain.The combination of them could quicken the speed of recovery and increase the degree of satisfaction of patients.

Objective: To evaluate the compensation level of the Urban Employee Basic Medical Insurance ( UEBMI ) and Urban Resident Basic Medical Insurance ( URBMI ) in Jiangsu province . Methods: Take catastrophic health expense as the bottom line of compensation ratio for the basic medical insurance, the benefit of hospitalization expenses of those joining the insurance as the actual line of compensation ratio, and quartile division was used to comparatively analyze the differences between the bottom line of compensation ratio and the actual line of compensation ratio. Results: Take 10%as the critical value of catastrophic health expense, the actual line of compensation level is higher than the bottom line of compensation level in UEBMI, and there is reverse in URBMI. Conclusion: In some extent, the compensation level of UEBMI has relieved the economic burden of the poor jointed group because of sickness, while limited compensation level of UEBMI is in need of further improvement.

To discover factors affecting the inpatient’ actual reimbursement rate of urban resident basic medical insurance ( URBMI ) . Methods: Using the method of correlation analysis and multiple stepwise regression modeling to identify the influencing factors. Results: The per capita funding criteria, rate of inpatient out of pocket payment over resident annual per capita disposable income and per capita hospitalization rate have significant effect on the actual reimbursement rate of URBMI. Conclusion: It is needed to establish a sustainable steady financing mechanisms for URBMI, improve the evaluation system of reimbursement policy and gradually raise the level of actual reimbursement.

Objective To evaluate the curative effect in treatment of hepatic metastases tumor with poorly blood supply through superselective transcatheter nutrient arterial full chemoembolization.Methods 75 cases of hepatic metastases tumors with poorly blood supply were treated by full chemoembolization through superselective transcatheter nutrient arterial infusion under DSA guided.Results After treatment 2～3 months,CT scans showed that totally 202 tumors in 75 cases,the tumors were fully filled with lipiodol in 189,large part in 11 and not well in 2.159 tumors were obviously shrunk,41 tumors were shrunk part,2 tumors were not obviously shrunk.The survival rate in 6 months,12 months,24 months,36 months and 3～5 years was 100%(75/75),85.3%(64/75),55%(41/75),42.7%(32/75)and 20%(15/75)respectively.Conclusion The transcatheter superselective nutrient arterial full filling chemoembolization for hepatic metastases tumor with poorly blood supply is a effective therapy.

To examine the role of glycogen synthase kinase 3 (GSK-3) in the apoptosis of pancreatic beta-cells to better understand the pathogenesis and to find new approach to the treatment of type 2 diabetes, apoptosis was induced by oleic acid (OA) in INS-1 cells and the activity of GSK-3 was inhibited by LiCl. The PI staining and flow cytometry were employed for the evaluation of apoptosis. The phosphorylation level of GSK-3 was detected by Western blotting. The results showed that OA at 0.4 mmol/L could cause conspicuous apoptosis of INS-1 cells and the activity of GSK-3 was significantly increased. After the treatment with 24 mmol/L of LiCl, a inhibitor of GSK-3, the OA-induced apoptosis of INS-1 cells was lessened and the phosphorylation of GSK-3 was increased remarkably. It is concluded that GSK-3 activation plays an important role in OA-induced apoptosis in pancreatic beta-cells and inhibition of the GSK-3 activity can effectively protect INS-1 cells from the OA-induced apoptosis. Our study provides a new experimental basis and target for the clinical treatment of type-2 diabetes.
Apoptosis/*drug effects ; Cell Line ; Fatty Acids, Nonesterified/*pharmacology ; Glycogen Synthase Kinase 3/*metabolism ; Insulin-Secreting Cells/*cytology ; Oleic Acid/pharmacology ; Phosphorylation