Objective To study the effect of three dimensional conformal intensity modulated radiotherapy and prognostic factors for postoperative local recurrent esophageal squamous cell carcinomas.Methods A total of 468 patieuts with postoperative local recurrent esophageal squamous cell carcinomas were retrospectively analyzed.The median interval between surgery and recurrence was 14.95 months (2-252 months).There were 45 patients with supraclavicular lympy node relapse,291 with mediastinal lymph node relapse,4 with abdominal lymph node relapse,15 with anastomosis relapse,89 with supraclavicular and mediastinal lymph node relapse,11 with anastomosis and mediastinal lymph node relapse,7 with mediastinal and abdominal lymph node relapse,1 with supraclavicular and anastomosis relapse,2 with supraclavicular and abdominal lymph node relapse,3 with anastomosis,mediastinal and supraclavicular lymph node relapse.There were 224 patients who received three-dimensional conformal radiation therapy,and the other 244 patients of intensity-modulated radiation therapy,with a median dose of 59.4 Gy (40-70 Gy).A total of 166 patients received adjuvant chemotherapy.Kaplan-Meier method was used to calculate the survival rate;Log-rank test was used for univariate prognostic analysis;Cox regression test was used for multivariate prognostic analysis.Results The follow-up rate was 95.3％.The recent curative effect in the effective rate was 81.6％,with 41.2％ CR rate.The overall 1,2,3,4 years of survival rates after radiotherapy were 61％,32％,21％,14％ respectively and the median survival time was 17.6 months.Univariate analysis showed that age,.pathologic stage,the number of positive lymph node cleaning,the recurrence area,single or multiple lesions,the size of the lesion,overall response rate,radiation dose,and chemotherapy (x2 =4.814-247.322,P ＜ 0.05) were associated with prognosis.Multivariate analysis showed that age,pathologic stage,the recurrence area,single or multiple lesions,the size of the lesion,overall response rate,radiation dose,and chemotherapy (P ＜0.05) were independent prognostic factors.A total of 370 patients had progressive diseases after radiotherapy,176 had local failure 47.57％ (176/370),148 had distant metastasis 40.00％ (148/370) and 16 had both local and distant failures 4.32％ (16/370).One case died of pneumonia;2 cases died of acute myocardial infarction;1 case died of cerebral hemorrhage;26 cases died of unknown cause (including lost to follow-up).Lung was the most common distant metastatic site.Conclusions Radiotherapy may improve the survival of esophageal squamous cell carcinoma patients with postoperative recurrence.Patients with less than 70 years old,early postoperative stage,single recurrent lesion,initial small lesions,response to radiotherapy,radiation dose of higher than 59.4 Gy,chemoradiation might have better prognosis.

Objective To analyze setup errors and guide the calculation of margins from clinical target volume (CTV) and planning target volume (PTV) in esophageal cancer patients treated with tomothcrapy by the MVCT image-guided system.Methods Sixty-four esophageal canccr patients trcated with tomotherapy in our hospital in 2016 were randomly selected.MVCT images were acquired after patients' positioning and co-registered with KVCT images.The setup errors of x,y,and z translations and roll rotation were analyzed with the t-test or one-way ANOVA.Meanwhile,PTV margin was calculated based on the formula of M =2.5 Σ + 0.7δ Results According to the formula,the CTV-PTV margins in the x,y and z directions are slightly different between cancers located in the cervical,upper thoracic,middle thoracic,and lower thoracic segments.In patients with upper thoracic esophageal cancer,the average setnp error in the yaxis was lower when the head-neck-shoulder thermoplastic film fixation was used than when somatic thermoplastic film fixation (P=0.000);the setup errors of z-axis with somatic thermoplastic film fixation in the fifth and sixth weeks were slightly less than those in the first several weeks (P =0.036);the setup errors acquired by three image registration patterns were similar (x-axis P=0.868,y-axis P=0.491,z-axis P=0.169,roll P=0.985).Conclusions In the treatment of patients with esophageal cancer,the setup errors are large,but the MVCT in the TOMO HD system can greatly reduce the setup errors,ensuring the accuracy of each treatment.It is further recommended that in clinical practice,different CTV-PTV margins should be used for the treatments of esophageal cancers located in different segments.Patients with upper thoracic esophageal cancer are advised to use the head-neck-shoulder thermoplastic film fixation.

Objective To conduct a pilot study on genome-wide in vivo protein-RNA interactions in E.coli.Methods Bacterial lysate was treated with RNase before the RNA fragments protected by proteins were extracted from treated lysate and used to construct cDNA library that was applied to high-throughput sequencing .Finally, the transcripts bound by proteins were obtained by bioinformatics analysis .Results A total of 3193 transcripts were obtained , including 2234 mRNAs, 47 sRNAs, 39 tRNAs, 11 rRNAs, and 862 intergenic regions .Conclusion Some information of transcripts interacting with proteins in E.coli is acquired , which will facilitate further studies of protein-RNA interactions .

Objective To explore the effects of penile erectile dysfunction (ED) on the quality of life in male renal transplant recipients.Methods 150 cases of male married recipients undergoing renal transplantation were selected randomly.The recipients were divided into ED group (n =63) and non-ED group (n =87) through the IIEF-5 score.The Short Form-36 Health Status Survey (SF-36)and Hamilton Anxiety Scale were used to compare their living quality and the state of mental health between the two groups,respectively.Results The SF-36 scores in ED group in General Health,Vitality,Social Function,Role Limitation due to Emotional Problems,Mental Health were significantly lower than those in non-ED group (P＜0.05).There were 13 cases in ED group with anxiety disorders (20.6％),significantly more than in non-ED group (3.4％),P＜0.05.Conclusion ED is an important influencing factor for the quality of life in male kidney transplant recipients.

Objective To compare the dosimetric difference among TomoDirect (TD) radiotherapy,Helical Tomotherapy(HT) and volumetric modulated arc therapy(VMAT) in the treatment of upper thoracic esophageal carcinoma.Methods A total of 15 patients with cT2-4 N0-1 M0 upper thoracic esophageal squamous cell carcinoma were enrolled.Three plans were generated using the same dose objective for each patient:TD,HT and VMAT.Dose-volume histogram (DVH),homogeneity index (HI),conformal index (CI),dose at organ at risk (OAR),delivery time and monitor unit (MU) were compared among different plans.Results The D2 and D values in the HT and TD plans were significantly lower than those in the VMAT plans.The D98 value in the TD was similar to that in the HT,but lower than that in the VMAT.The HI of HT was significantly better than those of TD and VMAT (F =81.603,P ＜ 0.05).For the CI,there was no significant difference among the three techniques (P ＞ 0.05).For the V15 of lung,HT was significantly higher than TD (t =-2.626,P ＜0.05) and VMAT (t=3.547,P ＜ 0.05).The V20 of lung in TD was similar to that in HT,but higher than that in VMAT (t =2.824,3.052,P ＜ 0.05).The Dmax of spinal cord showed no significant difference among the three techniques.VMAT had a significantly shorter delivery time and lower MU compared with HT and TD (t =21.617,15.693,10.018,7.802,P ＜ 0.05).Conclusions HT and TD could gain a better planning target volume (PTV) coverage and HI than VMAT in the treatment of upper thoracic esophageal carcinoma.However,VMAT achieved the lowest lung V20,the least Mus and the shortest delivery time.HT achieved a better PTV coverage compared with TD,but TD had a lower lung V15 Mus and shorter delivery time compared with HT.

Objective:To explore the clinical utility of tongue pressure resistance feedback training in the treatment of post-stroke dysphagia.Methods:Twenty stroke survivors with dysphagia were randomly divided into an experimental group and a control group. Both groups were given conventional swallowing rehabilitation training, while the experimental group was additionally provided with tongue pressure resistance feedback training. Before and after the treatment, MBSImp analysis and the Rosenbek penetration aspiration scale were used to quantify the control of the tongue, food delivery, oral residue, laryngeal elevation, hyoid bone movement, epiglottis turnover, larynx closure, vestibular larynx closure, pharyngal peristalsis and contraction, opening of the upper esophageal sphincter UES, contraction of the base of the tongue, pharyngeal residue and aspiration.Results:No significant differences were observed between the two groups before the intervention. Afterward the average pharyngeal period and aspiration score of the experimental group had decreased significantly compared with the control group′s values.Conclusions:Tongue pressure resistance feedback training is effective in improving pharyngeal swallowing and reducing the risk of aspiration after swallowing.

Objective:To explore the application of ArcCheck system in the validation of Helical and Direct tomotherapy plans for esophageal cancer and summarize relevant experience.Methods:The Helical and Direct tomotherapy verification plans were established for 32 patients with esophageal cancer at different positions according to the doctor′s instructions, which were verified by the ArcCHECK system to compare the passing rate of the results.The correlation between the volume of the target area and the passing rate of the planned verification was analyzed. The therapeutic verification plan with a small target volume was made. The target area was placed at the center of ArcCHECK phantom and the area of detectors to statistically compare the verification passing rates.Results:Helical plan showed a significantly higher passing rate than the Direct plan ( P<0.01). The correlation coefficients between the target volume and the passing rate of the Helical and Direct plans were -0.364 and -0.042, and the P values were 0.041 and 0.819, respectively. For the Helical plan, when the 3%/2mm criterion was adopted, there was significant difference between placing the high-dose area at the center of the phantom and the area of detectors ( P=0.005), and the passing rate of the latter was higher. There was no significant difference in the other cases (all P>0.05). Conclusions:The passing rate of the Helical plan is generally higher than that of the Direct plan, which may be related to the angular response of the ArcCHECK detector and the fact that more reference points are not included for calculation due to low-dose radiation. In addition, it may also be related to the higher requirements of Direct plan for tomotherapy dose control system. In the Helical verification plan, when the 3%/3mm criterion is adopted, the larger the target volume, the higher the possibility of lower passing rate, whereas the correlation coefficient between them is relatively low. The high-dose area can be verified by the plans at the center of the phantom or the detection point. With the comprehensive consideration, we suggest putting it at the center of the phantom.

Objective To improve the efficiency of result reporting and ensure the accuracy of the results by establishing autoverification system in Clinical Chemistry and Immunology Laboratory.Methods The study followed the requirements of the Clinical Laboratory Standards Institute(CLSI)AUTO-10A and ISO 15189:2012.In addition,seven categories of verification rules were encoded using the autoverification function of the CentraLink?Data Management System on the Aptio?Automation platform.These rules included Clinical Diagnostic Standard(CS), Sample Status(SS), Quality Control Severity(QS), Instrument Error Flags Severity(IS), Normal Severity(NS), Delta Check Severity(DS), and Logical Assessment Standard(LS).Various modules of Aptio Automation,laboratory information system(LIS)and hospital information system(HIS)were integrated using the CentraLink system to establish the autoverification system.Results The autoverification system was set up and tested from August 2015 to April 2016.In total, the system ran 4 496 425 tests on 366 180 chemistry specimens.The overall autoverification rate for tests performed increased from 53.4% to 87.0%.Glucose had the highest rate (98.3%)while CKMB had the lowest rate(63.6%).Average TAT for result verification decreased by 97.7%,from 46.3 minutes to 3.7 minutes.The system ran 410,040 tests on 160 119 chemiluminescence specimens.The autoverification rate for tests performed increased from 40.2%to 89%.C-P had the highest rate(98.4%)while A-TPO had the lowest rate(58.7%).Average TAT for result verification decreased by 77.4%,from 14.6 minutes to 3.3 minutes.From May 2016 to January 2017(when autoverification was employed),compared with the same period in 2014(when manual verification was employed),the following changes were observed with no increase in staff capacity:a)Volume of routine chemistry tests increased by 46.4%,and median TAT for tests decreased by 41.9%, from 118 minutes to 83 minutes; b)Volume of chemiluminescence tests increased by 24.5%and median median TAT for tests decreased by 52.4%, from 131 minutes to 86 minutes;c)Median TAT for critical values decreased by 50.5%; d)Rates of tests that did not go through autoverification were 88.2% for NS,6.05% for SS, 2.40% for DS,2.00% for LS, 0.97%for IS,and 0.43% for CS; e)Rates of abnormal specimen status identified by Aptio Automation were 7.13‰for jaundice,5.39‰ for blood lipids,2.20‰ for hemolysis,0.17‰ for barcode error, and 0.15‰ for insufficiency;f)Error rate decreased to 0.00%;and g)staff satisfaction increased from 85%to 100%.Conclusion Autoverification of results by using the CentraLink Data Management System can achieve quality control over the entire process of clinical laboratory testing, ensure accuracy of test results, improve work efficiency, decrease TAT, minimize the error rate, avoid skill variation of staff, reduce the pressure of performing manual verification,and improve medical security.

Objective: To understand the real experience of oral hygiene care of perioperative oral cancer patients. Methods: Qualitative descriptive research was adopted. Semi-structure in depth interviews were conducted among 17 postoperative oral cancer patients. NVivo 11 was used to manage and sort out the original data, data was analyzed with the content analysis of Colaizzi. Results: Six themes regarding oral hygiene care was extracted, including the diversity of methods of oral hygiene and the care provider, patients have limited knowledge about oral hygiene care and the relative education is lacking, the change of function, structure and the degree of comfort of mouth impact the oral hygiene care, patients′ feedback on oral hygiene care is complicated, patients′ oral care related emotional experience is rich, oral hygiene care experience of elderly and non-elderly patients with oral cancer has few difference. Conclusions The oral hygiene care of perioperative oral cancer patients needs to be further standardized, the instruction of patients′ oral hygiene care needs to be enhanced, more attention should be paid to the popularization of disease knowledge, so as to optimize patients care and do a good job in disease prevention.

The treatment of oral cancer patients mainly involves surgery in combination with radiotherapy and chemotherapy. This paper reviews the clinical features of perioperative patients with oral cancer, including oral flora imbalance, oral complications after radiotherapy and chemotherapy, the presence of oral incisions (and flaps), special dietary needs, and airway management. In connection with the above characteristics, this article analyzes the necessity of three aspects of oral care to improve the patient’s comfort and prevent pulmonary and surgical site infections, with the goal of providing a reference for oral care research on patients undergoing oral cancer surgery and laying a foundation for the construction of comprehensive oral care programs during the perioperative period for patients with oral cancer.