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.

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 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 develop biomimicking chitosan scaffolds with longitudinally oriented micro-channels,and investigate their efficacy in bridging 15 mm sciatic nerve gap in rats.[Methods]Chitosan scaffolds with longitudinally oriented micro-channels were fabricated using unidirectional freezing-dry methods.The chitosan scaffolds were used to bridge 15 mm nerve defect in rats,and their efficacy in bridging nerve gap was evaluated by morphometric analysis,retrograde labeling,electrophysiological studies and behavioral analysis.[Results]The chitosan scaffolds developed in the present study showed longitudinally oriented micro-channels,which resembled the dimensions of basal lamina channels in normal nerves.Implantation of chitosan scaffold achieved axonal regeneration and functional recovery similar to autograft implantation in vivo.[Conclusion]The chitosan scaffolds have inner microstructures which resemble the basal lamina channels in normal nerves.The chitosan scaffold may be used as an alternative to autograft in bridging nerve gaps.

Objective To study the MRI manifestations of hemangioblastomas.Methods MRI data of 27 cases of hemangioblastomasproved by surgery and pathology were analyzed retrospectively.Results Hemangioblastomas were often located in hemispherium of cerebellum.All cases could be divided into three types : cyst-nodule type cyst-solid type and purely solid mass type.The large cyst and small nodule sign were characteristic manifestations of the cyst-nodule type,the signals of the fluid of the cyst were higher than that ofcerebrospinal fluid on MRI.The nodules or solid potions of the mass were showed as equal or slight long T_1 and slight long T_2 signalintensity,and were obviously enhanced.The blood vessel flow-void-sign around and inside the solid parts of the masses could be seen,and had a close relation with surrounding meninges.Conclusion MRI is a effective method in diagnosing hemangioblastomas,but the atypical cases should be differentiated from cystic astrocytoma,meningioma and metastesis.

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

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.

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 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.

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.