Objective To evaluate the feasibility of using medical image analysis for adaptive radiotherapy of lung cancer by drawing the individual contours automatically or interactively and adjusting the planning target volume weekly for reducing the volume of the excessive irradiated normal lung tissue.Methods Many CT images of the GTV and dynamic X-ray fluoroscope data of 23 patients were acquired and all the data were used for working out the tumor radiotherapy plan(TPS) and positioning the patient and to measure reduction in GTV volume.A planning study was conducted to determine the amount of lung-sparing that could have been achieved if adaptive therapy had been used.Treatment plans were created in which the target volumes were reduced after tumor reduction was measured.Results A total of 6313 CT imaging sessions and 78 groups of X-ray dynamic fluoroscope data were performed on 23 lung patients.The GTV was reduced by 70%～80% during the course of treatment.Based on these treatment planning studies,the dose of ipsilateral lung can be reduced significantly by adapting the treatment delivery.Conclusion Medical image analysis can be used to position the GTV and CTV of the tumors.This technology can help to work out the individual TPS and adjust the radiotherapy treatment plan adaptively during the course of treatment and reduce the dose of normal tissues as well as insure the effect of tumor treatment.

Objectives:To study the clinical significance of prealbumin and retinol binding protein in parenteral nutrition assessment. Methods:Serum prealbumin,retinol binding protein,transferrin and albumin were determined respectively before and a week after total parenteral nutrition(TPN) support in 40 cases with gastrointestinal diseases. Results:A week after TPN,plasma prealbumin and retinol binding protein concentrations increased significantly( P

BACKGROUND: Effect of hypoxia on osteogenic differentiation of bone marrow mesenchymal stem cells (BMMSCs) has been differently reported. Those differences might cause by varying volume fraction of oxygen and varying source of BMMSCs. OBJECTIVE: To compare the biological differences between placenta and BMMSCs under hypoxia.METHODS: Human placenta amniotic mesenchymal stem cells (hAMSCs) and rabbit BMMSCs were isolated by two step proteinases and whole bone marrow adhesion, respectively. hAMSCs and BMMSCs at the same passage were seeded in 12-well plates at an initial cell density of 2 × 10~4 cells per well with α-MEM containing 10% FBS. Then, the cells were cultured under 5% O_2 or 20% O_2 for 12 days. hAMSCs and BMMSCs at the same passage were seeded in 12-well plates at an initial cell density of 1 × 10~5 cells per well with osteogenic medium. Then, the cells were cultured under 5% O_2 or 20% O_2 for 14 days. Cell growth curve, the specific glucose consumption rates and specific lactate production rates, and osteogenic differentiation were detected. RESULTS AND CONCLUSION: Compared to normal oxygen, hypoxia promoted the proliferation and osteogenic differentiation of MSCs. When compared to BMMSCs, statistically significant enhancement of the growth of hAMSCs by hypoxia was observed. hAMSCs cultured under hypoxia exhibited lower glucose consumption and lactate production in contrast with BMMSCs. Furthermore, comparison between hAMSCs and BMMSCs showed that the alkaline phosphatase expression of BMMSCs was significantly enhanced by hypoxia and was markedly higher compared with hAMSCs. The amount of calcium deposition was also enhanced by hypoxia, but there were no statistically significant differences between hAMSCs and BMMSCs.

Objective To analyze the clinical features and image manifestations of hepatic inflammatory myofibro-blastie tumor( HIMT), and to investigate the optimal management of this disease. Methods From January 2000 to January 2007, clinical data with HIMT verified by pathology were retrospectively analyzed. Results Eight patients 5 men, 3 women were included in the analysis. The mean age was 41.3 years. All eases did not have a history of previous hepatitis and liver cirrhosis, and 6 with no typical clinical symptoms. Hepatic functions, serum levels of AFP, CEA, CA199 in these patients were all within the normal ranges. Preoperative imaging by ultrasonography and computed tomography(CT) were not indicative of HIMT. Morphologic features by CT scan were summarized: at nonenhanced CT, the masses appeared as low density lesions. At contrast enhanced CT, the masses exhibited mod-erate intensification in the solitary areas, and the intensification peak appeared during the period of artery. During the period of portal vein and delayed scan, the masses showed low to moderate intensification in the solitary areas, in which the degree of intensification was a little lower than that in peripheral liver parenchyma. Gross specimens showed single solid masses, 3～12 cm, without classic envelope. All the patients underwent surgery whereas no incidence of perioperative death. Diagnosis of HIMT was confirmed by pathology of surgical specimens. Condusion Although typical presentation and the diagnostic workup are still lacking for HIMT, CT is helpful in diagnosing HIMT as well as combined with clinical findings. Surgical management would be likely the optimal treatment of this disease.

Background: The incidence of inflammatory bowel disease (IBD) is increasing in recent years, and the etiology and pathogenesis of IBD remain unclear.Studies showed that disorder of bile acid metabolism plays an important role in the pathological process of experimental colitis.However, serum bile acid profile in IBD patients has not been reported.Aims: To investigate the changes of serum bile acid profile in patients with IBD.Methods: Seven healthy controls, 15 patients with ulcerative colitis (UC) and 16 patients with Crohn's disease (CD) at Shanghai Xin Hua Hospital were enrolled.High-performance liquid chromatography-mass spectrometry was used to determine serum bile acid profile.Results: No significant differences in serum concentrations of primary bile acid cholic acid (CA), chenodeoxycholic acid (CDCA), glycocholic acid (GCA), taurocholic acid (TCA), glycochenodeoxycholic acid (GCDCA) were found between UC or CD and controls (P>0.05).Compared with controls, serum concentration of secondary bile acid deoxycholic acid (DCA) in UC patients was significantly decreased (P<0.05), glycodeoxycholic acid (GDCA), taurodeoxycholic acid (TDCA) in CD patients were significantly decreased (P<0.05), serum concentration of lithocholic acid (LCA) in UC and CD patients was significantly decreased (P<0.05).Conclusions: The serum bile acid profile in IBD patients is significantly changed, which suggests that it may be involved in the pathological process of IBD.

Objective: To overview the experience of postoperative nutritional management in live transplant patients. Methods: Postoperative nutritional therapy and nutritional status assessment in 18 liver transplantation (2 patients undergone retransplantation) were retrospectively analyzed. During the first 3 days after operation, patients were supported with total parenteral nutrition (TPN) and supplied with human albumin. On the 4th and 5th days after operation, patients were provided with parenteral nutrition (PN) and enteral nutrition (EN). And on days 6～10 after operation, patients were gradually transferred to total enteral nutrition and they restored the oral intake completely on days 12～18 after operation. Recombinant human growth hormone was postoperatively injected for 4～7 days. Results: Despite 3 cases who died from brain hemorrhage, respiratory failure and acute rejection respectively, other 13 cases recovered fluently. Conclusions: Appropriate postoperative nutritional therapy facilitated the recovery of liver transplant patient.

Objective To evaluate the diagnostic value of computed tomography enteroclysis/enterography (CTE),magnetic resorance enteroclysis/enterography (MRE) and ultrasonography (US) in Crohn's disease (CD) by Meta-analysis.Methods Segmental intestinal wall thickening and strengthening was taken as image diagnostic indicators in CD.Endoscopic and histopathologic findings and follow-up results were set as diagnostic standard.Retrieve and literature inclusion criteria were developed.The papers of CD diagnosed by CTE,MRE and US which met the criteria were searched and screened.The quality of the papers was evaluated by quality assessment of diagnostic accuracy studies (QUADAS).The diagnostic efficacy of CTE,MRE and US was compared,which included sensitivity,specificity,positive likelihood ratio and negative likelihood ratio,positive predictive value (PPV) and negative predictive value (NPV).Results Among the 2197 retrieved literature,a total of 12 papers met the criteria and nine of which were blinded study.The papers were grouped by three different imaging techniques and underwent QUADAS scale scoring.One paper was about CTE and MRE comparative study,so there were six papers in CTE group,the scores of all the six papers were over 10 and all of them were blinded study.There were four papers in MRE group,the scores of three papers were over 10 and all of them were blinded study.There were three papers in US group,the score of one paper was over 10 and two of these three papers were blinded study and one with unclear evaluation.The sensitivity of CTE group was the highest (89 ％),while the specificity (90 ％) was lower than that of US group (95％).The PPV (93％),NPV (95％),positive likelihood ratio (15.16) and negative likelihood ratio (0.17) of US group were the highest,those of CTE were secondary (PPV 91％,NPV 82％,positive likelihood ratio 6.25 and negative likelihood ratio 0.15).The sensitivity (74％),specificity (84％),PPV (80％),NPV (80％),positive likelihood ratio (4.18) and negative likelihood ratio (0.33) of MRE group were lower than both US group and CTE group.Conclusions The sensitivity of CTE in CD diagnosis is better than that of MRE and US,while other diagnostic indicators are poorer than US.Even though US has high diagnostic value in CD,more well designed large sample study were still needed for further evaluation.

Objective To report three cases of fulminant ulcerative colitis (FUC) treated with infliximab (IFX) and the positive result for clinical purpose. Methods Three patients with FUC were infused with IFX (5 mg/kg) at interval of 0, 2, 6 wk. Sulfasalazine or probiotics was used for the maintanance of remission. The mucosal healing was evaluated by endoscopy and patholoic examination. ResultsComplete remission was found in 3 patients with FUC. Eight weeks after IFX withdraw, complete remission was found in two of three cases demonstrated by endoscopy, except for one case died from refractory ventricular tachycardia. The remaing 2 cases showed no active manifestation during 8 months' follow-up. Conclusion IFX therapy results in complete remission in 3 cases with FUC. However, further randomized control study is warranted for concrete evaluation on salty and application clinically.

Objective To investigate the diagnosis and treatment of pseudomyxoma peritonei (PMP) and provide a reference for diagnosis and treatment of PMP.Methods The clinical features,laboratory examinations,treatment and outcomes of 8 PMP misdiagnosed cases were analyzed with recent relevant reference.Results Ultrasonography,CT,peritoneal cytological examination,tumor markers results are helpful for diagnosis of PMP.PMP will be confirmed and classified by pathological examination after operation.Complete cytoreductive surgery (CRS)or major debulking surgery (MDS) of the tumor combined intraperitoneal chemotherapy and systemic chemotherapy,eight patients in seven cases survived 4-71 month range,one patient died of respiratory failure of pulmonary infection after the third operation.Conclusions Ultrasonography,CT,peritoneal cytological examination,tumor markers tests help avoid misdiagnosis of PMP before operations.Intraoperative findings follow after PMP,CRS or MDS should be executed in the operation or the next time.Intraperitoneal chemotherapy and conventional chemotherapy can improve survival in patients with PMP and prolong their survival time.

Currently medical students are short in ability of doctor-patient communication and lack of professional training in doctor-patient communication.It is essential to explore ways and means of teaching clinical doctor-patient communication for medical students.Clinical doctor-patient communication training courses were carried out with internships by way of explaining the establishment of a good doctordoctor-patient communication relationship,preparation and investigation analysis of doctor-patient communication information,doctor-patient communication skills,evaluation and adjustment of doctor-doctor-patient commu-nication,doctor-doctor-patient communication in the legal and regulatory issues.Medical students were trained in the good doctor-doctor-patient communication relationship building,information collection,infor-mation giving,respect and understanding,ending doctor-patient communication skills.And after the training medical students' doctor-patient communication ability obtained a certain improvement,which means this curriculum of clinical doctor-patient communication training courses is worthy of further promotion.