Objective To verify the dose delivery accuracy of volumetric-modulated arc therapy plan by log-file analysis of linear accelerator that can be created when a dynamic delivery occurs.Methods Accelerator log file in binary format recorded the accelerator execution plan for each control point corresponding to the gantry angle,multi-leaf collimator leave position,cumulative machine monitor units ( MU).These information were read from the accelerator log file with Matlab7.1,then the original control points in the plan file replaced the corresponding information for the log,which generated a new plan.New plan was exported into the planning system to reculculate the dose.The volume dose histogram (DVH) and dose distribution was contrasted to determine the accuracy of the accelerator plan of implementation between two plans.Results Compared with the original plan,antry angle difference over ± 1° accounted for about 35％ of the entire arc of control points in 4 of 12 arcs and the percentage of the leave error of ±0.5 mm was about 95％.MU error of a single control point was larger,but the cumulative MU for each are was small which was located between-0.09％ to 0.11％ in the selected 12 arcs.Between the targets,the maximum dose,minimum dose,the mean dose differences were from-0.07％ to 0.42％,-0.38％ to 0.40％,0.03％ to 0.08％,respectively.The maximum dose and mean dose differences of organs at risks were located from-1.16％ to 2.51％,-1.21％ to 3.12％,respectively.Conclusions Accelerator log-file analysis to verify the VMAT plan nan be supplyed to the experimental method supplement.

Objective To compare the characteristics of dose distribution between hypofractionated intensity modulated radiotherapy (IMRT) and hypofractionated stereotactic radiotherapy (SRT) plans in lung tumor and to select an optimal clinical approach. Methods SRT plans were designed for 16 patients with lung tumors who had received IMRT between April 2007 and April 2008. The dose distribution of target volume and normal tissues, conformal index (CI) and heteregenous index (HI) were analyzed using the dose-volume histogram (DVH) for the IMRT and SRT plans. Results The mean dose and equivalent uni-form dose of planning target volume (PTV) in IMRT were similar to those in SRT. SRT had significantly better CI and HI than IMRT (t = 2.77, P < 0.05 and t = - 4.38, P < 0.01 ). The mean lung dose of IMRT and SRT was (492.4 ±368.5) cGy and ( 310.0 ± 73.1 ) cGy, respectively ( t = 1.68, P > 0.05 ). The lung V20 of IMRT and SRT was 6.9% ± 2.1% and 4.2%± 1.9%, respectively ( t = 3.30, P < 0.01 ). No sig-nificant differences were found in the mean dose to the heart or the spinal cord between IMRT and SRT. Conclusions When PTV is less than 57 cm3 or the long diameter of tumor is less than 4.7 cm, hypofrac-tionated SRT has similar dose distribution to hypofractionated IMRT, while the lung dose was lower in the former.

Objective To compare the application of CDU and CTA in preoperative planning of lower extremity perforator flaps.Methods From February, 2013 to December, 2014, 40 patients who underwent reconstruction with perforator flaps harvested from lower extremities were treated.The position, caliber and route of the perforator vessels were detected by CDU and CTA pre-operatively.The results of the pre-operative navigation with both imaging techniques assisted the selection of the perforators and the flap design and were verified during the operation.Results CDU had a higher accuracy in terms of identification (95.0％ vs.90.0％) and location (95.0％ vs.82.5％) of the perforators in the lower extremity.There was no significant difference between the two methods in examination and image analysis time.All the flaps survived, besides 1 flap presented with a 2.0 cm × 2.0 cm distal necrosis which healed after regular dressing change.For 35 cases, the donor sites were closed directly while partial skin grafting were performed in 5 case.Conclusion Pre-operative imaging techniques are capable of offering valuable anatomical information of perforator vessels, which can make flap design more convenient, reduce donor site morbidity and improve the surgical results.The authors recommend CDU for pre-operative planning when harvesting perforator flaps from the lower extremity.

Objective To evaluate the molluscicidal effect and the using value of qiangluocide powder by dusting in the fields. Methods The two different ways of dusting with qiangluocide and spraying with luomiecide for controlling snails were compared in the fields, and the cost-effectiveness was analysed. Results The corrected mortalities and the reduced rates for density of snails were 88.48%, 96.26%, 96.96%, 95.67%, and 87.58%, 95.40%, 96.14%, 96.67%, respectively, on the marshland in Longtan, Nanjing, 73. 65% , 98. 31% , 99. 22% , 99. 26% and 69. 30% , 98.14%, 98.84%, 98. 60% , respectively, on the marshland in Yizheng, Yangzhou, on 1 d, 3d, 7 d, 15 d after dusting with qiangliocide power; and those on 1d, 3d, 7d, 15d after the spraying with luomiecide were 69.15%, 88.01%, 86.46%, 85.56% and 75.27%, 84.99%, 87.50%, 87.96% on the marshland in Longtan, Nanjing, 18.70%, 63.11%, 1.25%, 12.60% and 34. 88% , 89. 02% , 45.37% , 46. 59% , respectively, on the marshland in Yizheng, Yangzhou. The st of dusting with qiangluocide powder was 0. 20 yuan/m2, and that of spraying with luomiecide as 0. 21 yuan/m2 for snail control in the fields. The costs of reduced one percentage for the cor rected mortalities and the density of snail were 6. 27-10. 07 yuan and 6. 21-10. 14 yuan, respectively, on 15 d after dusting with qiangluocide power and those on 15 d after spraying with luomiecide were 7. 36-83. 33 yuan and 7. 16-22. 54 yuan , respectively. Conclusion The dusting with qiangluocide powder is a promising new formulation, which is suitable for the areas without water resource and possessed of high effectiveness against snails. The method ofdusting with qian-gluocide powder for controlling snails is simple, convenient, cheap and easy to be carried out for the inspection and quality control.

Objective Currently, the prefabricated flap is used for reconstructing the post-burn scar in head and face.The aim is to analyze the nature of the post-op edema in the prefabricated flaps, to determine whether it is lymphedema, and to study the prognosis of the edema.Methods From January, 2011 to March, 2015, 18 cases of post-operation edema in superficial temporal fascia prefabricated flaps were studied and each case was followed for 5 months.We used ultrasound and indocyanine green (ICG) fluorescent imaging to study the nature of the edema.Apart from that, we monitored the recovery process of the post-operation edema by a) measuring the horizontal diameter of the flap by a tape, b) measuring the thickness of the flap by the ultrasound, c) monitoring the condition of edema by ICG and d) monitoring the reconstruction and recanalization of the lymphatic system by ICG.Results Pitting edema always occurred in the prefabricated flap from the first day after operation.These patients were diagnosed as mild lymphedema (7 cases), moderate lymphedema (10 cases), and severe lymphedema (1cases) by ultrasound and ICG florescent imaging.The degree of flap lymphedema improved gradually and it improved significantly from 3 days to 6 days post-op eration.The condition of flap lymphedema became stable from the 12 days post-operation.The fluorescence image of ICG showed that the stage of flap lymphedema improved from 3 weeks post-operation and the transportation capability of lymphatic vessels increased most from the 3 days to 6 days post-op eration.We also found lymphatic vessels reconnected from the 6 days post-operation and lymphatic system reconstructed following the direction to lymph nodes.We could discover the collecting lymphatic vessels from 2 months post-operation and the lymphatic system in prefabricated flap matured from 5 months post-operation.Conclusion The post-operation edema in the prefabricated flaps is lymphedema, the incidence rate of which is high.The lymphatic drainage system recovers in 6 days after the operation.It is reconstructed along the lymph nodes.The edema disappears in 2-3 weeks post-operation, the reconstructed the lymph system matures in 5 months.

Objective To understand the distribution,variance and dynamics of Oncomelania snails in the water system of the Bianmin River after the river bank being protected with concrete.Methods The snails in the water system of the Bianmin River were investigated with the systemic sampling method and environmental spot-checking method in spring from 2002 to 2005.The indexes including area with snails,area with infected snails,rate of frames with snails,density of living snails and infection rate of snails in different environments were collected,analyzed and compared year by year.Results From 2002 to 2005,in the main river of the water system of the Bianmin River,irrigation areas and the adjacent marshlands of the Yangtze River,the areas with snails were 20.94-31.88,39.30-48.08 hm2 and 275.13-292.31 hm2,respectively;the rates of frames with snails were 9.96%-21.88%,29.61%-58.54% and 62.14%-85.97%,respectively;the mean densities of snails were 0.97-1.86,0.92-3.96 snails/0.1 m2 and 7.72-11.15 snails/0.1 m2.In 2005,in the main river,irrigation areas and the adjacent marshlands,the rates of frames with snails were 21.88%,39.33% and 83.81%,respectively;the densities of living snails were 1.30,3.96 snails/0.1 m2 and 11.15 snails/0.1 m2.During the last four years,the rates of frames with snails increased quickly in the main river of the water system of the Bianmin River;the densities of snails increased by 4 times in the irrigation areas;the indexes mentioned above were stable in the adjacent marshlands of the Yangtze River.However,the rate of frames with snails in the marshlands was 2-3 times higher than that in the irrigation areas and the mean density of snails in the marshlands was 3-8 times higher than that in the irrigation areas.Conclusions The main factor causing the increase of snails is that the river beach has not been cleaned yet in the water system of the Bianmin River,and so the key of schistosomiasis control is that first,the river beach should be cleaned completely,and at the same time,strengthening the snail control in the irrigation areas and the snail surveillance and snail control with molluscicides in the outfalls of the rivers of the water system of the Bianmin River to the Yangtze River.

OBJECTIVETo investigate the therapeutic effect of heating and bandage treatment for chronic lymphedema of extremities accompanied with erysipelas.

METHODSFrom March 2004 to March 2013, 80 patients with chronic lymphedema of extremities accompanied with erysipelas were analyzed retrospectively. The patients underwent heating treatment (42 degree centigrade) with infrared light machine made by Shanghai Ninth People's Hospital, 2 hours a day, 20 hours for a session. Bandage treatment was adopted after heating treatment. 1 or 2 sessions were performed for each patient every year. The erysipelas occurring frequency, patients subjective feeling, treatment sessions and elastic material usage was recorded during the follow-up period. The erysipelas occurring frequency was tested by the method of rank and inspection. SPSS 17. 0 was used for statistical analysis.

RESULTSAfter heating and bandage treatment, the occurrence frequency of erysipelas was obviously controlled (Z = 7.598, P = 0.000). Erysipelas was not occurred any more in 60 (75%)patients. Remarkable reduction of occurrence frequency of erysipelas caused by various reasons was showed after treatment. Primary and secondary lymphedema after treatment were compared with those before treatment respectively, showing statistical difference (Z = 3.417 and 5.009, P = 0.001 and 0.000). Most of patients felt better subjectively. The relapse rate of erysipelas and lymphedema was lower if keeping using elastic material to give more pressure on extremities after therapy.

CONLUSIONSHeating and bandage treatment can obviously reduce the occurrence frequency of erysipelas. It can improve the quality of patients' lives. Simultaneously, the subsequent elastic material pressure therapy is essential.

Bandages ; Chronic Disease ; Combined Modality Therapy ; methods ; Erysipelas ; complications ; therapy ; Extremities ; Female ; Humans ; Hyperthermia, Induced ; methods ; Lymphedema ; complications ; therapy ; Middle Aged ; Pressure ; Recurrence ; Retrospective Studies ; Time Factors

Objective To evaluate the efficacy and toxicity of fractionated stereotactic body radiotherapy in treating patients with liver metastases. Methods From January 1997 to January 2007, 22 patients with liver metastases of total 33 lesions were treated with fractionated stereotactic body radiation therapy (SBRT). All patients were confirmed as unresectable and resistant to chemotherapy. The most common primaries were breast cancer in 12 patients and colorectal cancer in 5. Fifteen patients had metastases in the liver alone and 7 had concurrent metastases in other sites. Eighteen patients received one course of SBRT, and 4 patients got two courses. The median total dose was 40 (range, 30 - 60) Gy in 3 (range, 2 -6) fractions. Results All patients were followed up. The median follow up was 13.9 months (range, 5.0 -36. 4 months). The median size of the irradiated lesions was 2. 0 cm (range 1.0 -4. 3 cm) and the target volume was 3. 68 cm~3 (range 0. 45 - 77. 29 cm~3). The 1- and 2-year local control rate, overall survival rate and progression-free survival rate were 100% and 90%, 73% and 49%, 94% and 28%, respectively. No grade 3/4 SBRT related toxicities occurred. Conclusions SBRT, with high local control and tolerable complications, is an effective and safe treatment for liver metastases.

Objective Although aspirin resistance has been recognized to occur in patients with diabetes mellitus, the prevalence and related risk factors for aspirin resistance in elderly patients with diabetes mellitus have not been reported yet. The purpose of the present study was to evaluate the prevalence and potential risk factors for aspirin resistance in elderly patients with type 2 diabetes.Methods The 140 elderly patients [aged from 60 to 92 years, mean age (73.8±8. 0) years] with type 2 diabetes receiving daily aspirin therapy (≥ 75 mg) over one month were recruited. Platelet aggregation was measured by light transmittance aggregometry (LTA) and thrombelastograph (TEG)platelet mapping assay. Results By LTA, 6 patients (4.3%) of the diabetic patients were found to be resistant to aspirin therapy, 44 patients (31.4 %) were semi-responders. By TEG, 31 patients (22. 1%) were aspirin resistant. Among the 31 patients who were aspirin resistant by TEG, 3 were aspirin resistant by LTA. In the multivariate logistic regression analysis, female gender (OR= 5. 54,95%CI: 1.17-27.47, P=0.036) and homocysteine level (OR=1.15, 95%CI: 1.00-1.35, P=0. 043) were statistically significant risk factors for aspirin resistance by TEG. Conclusions The prevalence of aspirin resistance in elderly patients with type 2 diabetes is considerably higher in elderly female patients and in elderly patients with higher serum homocysteine level.

Objective To introduce the classification of the perforators of the superficial circumflex iliac artery(SCIA),and the superficial circumflex iliac artery perforator (SCIP) flaps based on different perforators have different characters and harvesting methods.To explore a set of coping strategy for the drawbacks of the SCIP flap.Methods Review 90 cases of SCIP flaps in August,2011 to June,2017.The pre-operative radiology navigation was conducted in all cases.Different surgical approaches were applied in flaps based on different perforators.The pedicle elongation method was adopted when necessary.The thickness of the flap,the length of the pedicle,the survival rate of the flap and the closure of the donor site were analyzed.Regular follow-up was performed after the operation.Results All flaps were followed-up for 6-15 months (average 8 months).Fifty-seven flaps were raised on the basis of the proximal perforators of the superficial branch of the SCIA,whereas 29 cases were based on the distal perforators from the deep branch,and in 4 cases,the pedicle was switched to the superficial inferior epigastric artery.In 8 cases,the arterial pedicle lengthen technique was applied with a maximum length of 10 cm.All donor sites were closed directly.Conclusion These surgical strategies simplified the intraoperative decision-making and conquered the shortcomings of the SCIP flap.It is believed that the SCIP flap can possibly become the new workhorse flap in the field of reconstructive surgery.