Brain metastases is a common cause of advanced tumors teeatment failure,and radiotherapy is one of the main treatment modalities.With the development of radiotherapy techniques,the survival and quality of life of patients with brain metastases have been significantly improved.Whole brain radiotherapy,stereotactic radiotherapy as well as the combination are the main treatment options,but the best fraction size,the most optional time and suitable patients need to be further investigated.Novel radiotherapy techniques such as simultaneous integrated boost have been a research hotspot.

As a neuroprotective measure,the application and research of mild hypothermia in clinical practice have been very extensive.Using mild hypothermia has achieved a positive efficacy in many diseases,such as brain damage after cardiac arrest and neonatal hypoxic-ischemic encephalopathy,etc.Although mild hypothermia has a large number of animal experiments and clinical studies in the treatment of ischemic stroke,and animal experiments have confirmed that it has the exact neuroprotective effect,the neuroprotective effect of mild hypothermia in the treatment of ischemic stroke has not yet come to a unified conclusion in the clinical studies.Its clinical efficacy does not seem to be as optimistic as expected.Therefore,it is necessary to analyze the transforming problems of mild hypothermia for treatment of ischemic stroke from animal experiments to clinical practice,and to provide ideas for the clinical application of mild hypothermia for treatment of ischemic stroke.

Objective To identify the effective traction conditions by comparing the effects of traction forces on the intervertebral disc under various mechanical conditions. Methods A three dimensional finite element model was used to carry out mechanical analysis of the traction under conditions with different forces and angles, then to carry out the comparative analysis of the stress distribution and the change of the volume of the intervertebral disc. Results In general, the stress distribution on the intervertebral disc was not even under different traction forces, The maximum stresses appeared at the back rim of the intervertebral disc. With the increase of the traction force and angle, the enlargement of the intervertebral disc volume increased, and the enlargement rate was more significant. Conclusion The volume of the intervertebral disc can be most effectively enlarged at the condition of 30?forward bending of the neck when a force of 90N was applied. This is the most effective traction condition.

OBJECTIVE To investigate the distribution and resistance the bacteria isolated from the patients of our hospital,to provide reliable laboratory evidences for the clinical precaution and therapy. METHODS The antibiotic susceptibility of 17 923 bacteria strains isolated from the inpatients between 1 Jan 2005 and 31 Dec 2007 of our hospital was detected. RESULTS The top nine bacteria were Pseudomonas aeruginosa,Staphyloccocus aureus,Escherichia coli,Enterococcus faecalis,Klebsiella pneumoniae,Acinetobacter baumannii,Staphylococcus epidermidis,Stenotrophomonas maltophilia and Enterococcus faecium.S.aureus was the top one in Gram-positive bacteria(G +bacteria).The occurrence of meticillin-resistant S.aureus(MRSA) statistically decreased.The occurrence of ESBLs + E.coli statistically increased. CONCLUSIONS These bacteria are still the common detected types in the patients of our hospital.It should be noted that K.pneumoniae and ESBLs + E.coli strains are increasing gradually and they are resistant to varieties of antibiotics.

Objective To explore the effect of continuous subglottic irrigation and aspiration in patients with artificial airway. Methods One hundred and twenty-eight patients with mechanical ventilation were randomly divided into observation group and control group with 64 cases in each group.The observation group was treated by continuous subglottic irrigation and aspiration,and the control group received traditional nursing.The two groups were observed and compared in terms of incidence of aspiration and ventilator-associated pneumonia.Result The incidences of ventilator associated pneumonia(VAP)and aspiration in the observation group were significantly lower than that in the control group(P<0.05).Conclusion Continuous subglottic irrigation and aspiration can effectively prevent aspiration and VAP among patients with artificial airway.

Objective To establish a mathematical model for describing and predicting the effectiveness of physical therapy on lumbar disc hernation(LDH).Methods Daily comprehensive physical therapy interventions including lumbar traction,mobilization and physical agents were administered to 31 LDH patients for 10 sessions.A visual analogue scale was used to measure the pain intensity before each session.The logistic curve model was used in the regression analysis.The first 2 to 9 pain measurements were involved in different predictive models,and the predictive results were compared among different models.Results In regression analysis,the global R2 was 0.719.In predicting analysis,the more measurements involved in the predictive model,the more effective the prediction.The predictive power was low when the model included less than 4 measurements.the prediction power was high when more than 5 measurements were used in the model.Conclusion The logistic model can describe and predict the effectiveness of multiple physical therapy on LDH patients.

Among 13 331 parturients from January 2011 to December 2013 in Peking University First Hospital, 6 162 cases required cesarean section, and the rate of cesarean section was 46.223％.The constituent ratio of cesarean section under general anesthesia was 1.75％, the constituent ratio of emergency cesarean section under general anesthesia was 60.2％, and the constituent ratio of the critically ill patients of ASA physical status ≥ Ⅲ was 16.7％.The main indication for general anesthesia was contraindication to neuraxial anesthesia or failure of neuraxial anesthesia.Of the 108 parturients who underwent cesarean section under general anesthesia, 33 cases were in laryngeal mask airway (LMA) group and 75 cases in intubation group.There was no statistically significant difference between intubation group and LMA group in terms of general data, emergency rate, percentage of patients or neonates admitted to intensive care unit, and neonatal Apgar score (P＞0.05).There were no airway-related complications such as difficult airway, aspiration or regurgitation in either group.In summary, general anesthesia was mainly suitable for cesarean section contraindicating neuraxial anesthesia and failed cesarean section, and the proportion of emergency operations was higher;LMA could be used for airway management in cesarean section under general anesthesia, but it must be placed correctly ensuring good airway sealing to prevent aspiration.

Objective To explore the clinical significance of the serum Epstein-Barr virus determined nuclear antigen 1 (EBNA1)/latent membrane protein 1 (LMP1) in patients with extranodal NK/T-cell lymphoma,nasal type (ENKL).Methods The serum EBNA1 and LMP1 were detected by realtime PCR in 36 ENKL patients hospitalized in Beijing Tongren Hospital from August 2010 to August 2013.Twenty healthy volunteers were recruited as controls.Results The median serum EBNA1 was 1.9 × 104 (ranged from 0 to 11.0 × 104) copies/μl in ENKL patients and 8.0 (ranged from 0 to 43.8) copies/μl in healthy volunteers.The median serum LMP1 was 3.9 × 103 (ranged from 118.3 to 24.0 × 103) copies/μl in ENKL patients and 3.3 (ranged from 0 to 33.3) copies/μl in healthy volunteers.Both EBNA1 and LMP1 were higher in ENKL patients than healthy volunteers (all P ＜ 0.01).The median EBNA1 and LMP1 in ENKL patients posttreatment were 1.0 × 103 (ranged from 0 to 2.0 × 103) copies/μl and 300.8(ranged from 0 to 825.7) copies/μl respectively,which were both significantly decreased than pretreatment (all P ＜ 0.05).The EBNA1 and LMP1 were decreased in effective treatment group versus ineffective treatment group (P ＜0.05).The serum EBNA1 and LMP1 were positively correlated with lactic dehydrogenase (LDH) level (r =0.364,0.546 ; P =0.040,0.012).Conclusions (1) The measurement of EBNA1/LMP1 may be useful in evaluating the therapeutic effect.(2)The serum EBNA1/LMP1 may reflect the tumor load in ENKL patients.

Objective The aim of this study was to investigate the correlation of serum copper levels and mental health in psychiatric shift nurses.Methods The participants were divided into day shift nurses(control group,n=60) and night shift nurses(n=60).The concentrations of trace mineral,serum biochemical levels,inflammatory and oxidative markers in blood samples of 120 shift nurses were measured.The depressive mood was measured with second edition of Chinese version of the Beck Depression Inventory,(BDI-Ⅱ).Results The night shift nurses showed moderate-to-severe depression levels,which were significantly higher than those of the day shift nurses,23.3％ (14/60) and 11.7％ (7/60) vs.6.7％ (4/60)and 1.7％ (1/60),x2=6.536,4.82,P ＜ 0.05.Night-shift nurses also had higher levels of serum copper,hs-CRP,IL-6,T-SOD and Cu-Zn SOD than the control group,(19.57±4.14) μmol/L vs.(18.03±3.20) μmol/L,1.32(0.78-1.89) rng/L vs.0.89(0.45-1.44) mg/L,68.54 (51.43-96.78) ng/L vs.56.39 (35.56-78.71) ng/L,(66.78±14.72) kU/L vs.(47.32±17.84) kU/L,(54.22±14.91) kU/L vs.(48.17±17.23) kU/L,t=-3.133～-2.057,P ＜0.01 or 0.05.BDI-Ⅱ scores correlated positively with serum copper,hs-CRP,IL-6,T-SOD and Cu-Zn SOD,r=0.248-0.457,all P ＜ 0.01.In night shift group,multivariate regression analysis showed that serum copper,hs-CRP,IL-6 and T-SOD (β=0.097-5.340,P＜ 0.01 or 0.05) were independently related factors influencing BDI-Ⅱ scores (R2 =0.609,P =0.000).Conclusions Serum copper may serve as an evaluation index for depressive mood in psychiatric shift nurses,and serum copper concentrations in night shift nurses should be monitored regularly.Clinical Trial Registry Chinese Clinical Trial Registry,ChiCTR-OOC-14005540.

The expression of CD107a,NKG2D on the surface of natural killer (NK) cells and serum soluble major histocompatibility complex class Ⅰ chain-related A (sMICA) level in patients with extranodal NK/T cell lymphoma,nasal type (ENKL) were detected.We found that CD107a expression was reduced on the surface of NK cells,suggesting impaired NK cell activity in ENKL patients,which may result from decreased NKG2D expression.