Objective To investigate the correlation between dose volume histogram(DVH)of tumor targets and organs at risk(OAR)at CT-image based 192Ir brachytherapy and effects and complications for patients with locally advanced cervical cancer. Methods Ten patients with FIGO stage ⅢB cervical cancer received CT image-based 192Ir intracavitary brachytherapy after 54 Gy of three-dimentional four-field pelvic external beam radiotherapy and concurrent weekly cisplatin chemotherapy. Before each brachytherapy,CT images were acquired with applicators in place. Gross tumor volume(GTV), clinical target volume (CTV)and OAR were contoured and inverse treatment planning was designed and optimized by using PLATO treatment planning system. Conventional two-dimensional plans were also designed for comparison.The total intracavitary brachytherapy dose was 30 -42 Gy in 5 -7 fractions. The patients were followed, and the local control and complications were analyzed. The biologically equivalent dose(BED)and biologically equivalent dose in 2 Gy fractions(BED2)for GTV, CTV and OAR were calculated. The minimum dose in the most irradiated tissue volume 2 cm3(D2 cm3)adjacent to the applicator of the sigmoid colon, rectum,bladder and small bowel was determined from the DVH. Results The 1-year local pelvic control rate was 90% and grade 1-2 late complication of sigmoid colon and rectum was 50%. No grade 3 or more complications developed. On CT-image based planning, the BED and BED2 to 90% of the CTV(D90)were 95.50 Gy ± 7. 81 Gy and 79. 73 Gy ± 6. 57 Gy. The BED and BED2 to 90% of the GTV(D90)were 101.86 Gy ± 7.27 Gy and 84. 95 Gy ± 6. 1 Gy. The volume enclosed by 90% of prescribed dose(V90)for GTV and CTV were 92% ±4% and 87% ±7% respectively. The D2cm3 for rectum and sigmoid colon were 74. 97 Gy ±1.64 Gy and 67. 93 Gy ± 4. 30 Gy(EQD2, α/β = 3). Comparing with 2D brachytherapy plans , CT - image based planning has improved D90 and V90 for GTV and CTV with similar dose at point A and rectum reference point. Conclusions Computer tomography-image based 192Ir brachytherapy has resulted in the better dose distribution to the tumor targets with excellent tumor control and acceptable toxicity.

Objective:To observe the efficacy, median progression-free survival (PFS) and adverse reaction induced by rh-endostatin injection (Endostar) plus platin-based chemotherapy for advanced non-small cell lung cancer (NSCLC).Methods:Fifty five histologically or cytologically confirmed advanced NSCLC patients received Endostar combined with platin-based chemotherapy for more than 2 cycles. The evaluated parameters included PFS, response rate (RR), clinical benefit rate (CBR) and adverse reaction. Results:Of the 51 patients who can be evaluated for response, 15 (29.4%) achieved partial response (PR), 27 (52.9%) had stable disease (SD), 9 (17.6%) had progressive disease(PD), no patient had complete response(CR). The overall RR was 29.4% (15/51) and CBR was 82.4% (42/51). The median PFS was 6.3 months. There were no significant differences in the short-term efficacy and PFS between the patients who had different pathological features (P=0.037), those had naive or relapsed diseases (P=0.101), or those received different chemotherapeutic regimens (P=0.232). The total white cells and platelets decreased by 72.7% and 54.5%, respectively. The frequency of grade Ⅲ or Ⅳ neutropenia and thrombocytopenia were 36.4% (20 caces) and 21.8% (12 cases), respectively. Four patients stopped the therapy for adverse reaction. One died of gastrointestinal hemorrhage; one had uncontrolled grade Ⅲ hypertension; one had superventricular arrhythmia; one had grade Ⅳ hepatic dysfunction. Conclusion:The combination of Endostar and platin-based chemotherapy increased the CBR and prolonged the PFS of the patients with advanced NSCLC. The toxicities were tolerable.

Objective To discuss the clinical effect of two-dimensional oral care for patients with mechanical ventilation by orotracheal intubation,and improve the quality of oral care.Methods Seventy inpatients with mechanical ventilation by orotracheal intubation from Feb 2011 to Jul 2012 in ICU were selected and randomly divided into experimental group (n ＝ 35) and control group (n ＝ 35).Experimental group was given two-dimensional oral care (oral swab just one time before intubation,and brush teeth and suction three times a day after intubation).Control group was given traditional oral care three times a day.Throat swab specimens were gathered for bacterial colony counts before intubation,and in 4 h,12 h,24 h,48 h after intubation,respectively.Bacteria quantitative culture was performed in sputum specimens and in throat swab specimens (one time per three days) after intubation.Oropharyngeal bacteria change and the incidence rate of ventilator associated pneumonia (VAP) were observed.Results Among all 70 patients,61 cases were valid,15 cases had VAP,and 8 cases died.In the experimental group,31 were valid,4 had VAP and 3 died,while in the control group,30 were valid,11 had VAP and 5 died.The difference of the incidence rate of VAP was statistically significant (x2 ＝ 4.643,P ＝ 0.040) and the difference of the incidence rate of death was not statistically significant (x2 ＝ 0.654,P ＝ 0.473).The difference of oropharyngeal bacterial colony counts had no statistical significance between two groups before intubation (t ＝-0.563,P ＝ 0.589),while the difference of oropharyngeal bacterial colony counts had statistical significance between groups in 4 h,12 h,24 h,48 h after intubation (t＝1.957,-2.520,-3.560,-2.165,respectively; P＜0.05).Conclusions Two-dimensional oral care can effectively reduce oropharyngeal bacterial colony,and decrease the incidence rate of VAP for patients with mechanical ventilation by orotracheal intubation.Thus it is a better nursing method to improve oral care quality.

OBJECTIVETo observe the clinical effect of dog-day acupuncture and tortoise-shell moxibustion combined with pelvic floor muscle exercises for treatment of female stress urinary incontinence.

METHODSSeventy one cases were randomly divided into two groups. Thirty six cases in the observation group were treated with acupuncture on Zhongji (CV 3), Zigong (EX-CA 1), Chize (LU 5) etc. and tortoise-shell moxibustion on Shenque (CV 8) combined with pelvic floor muscle exercises; while thirty five cases in the control group were treated with only pelvic floor muscle exercises. The scores of the International Consultation Committee on Incontinence Questionnaire Short Form (ICI-Q-SF) and the Medical Outcomes Survey Short Form-36 (SF-36) were evaluated before and after treatment, and the scores of SF-36 were also compared with 35 cases in normal group.

RESULTSThe total effective rate of 91.7% in the observation group was higher than that of 77.1% in the control group (P < 0.05). The dimensions of SF-36 of stress urinary incontinence patients were remarkably lower than those of normal group (all P < 0.05). The scores of ICI-Q-SF were decreased while the scores of SF-36 were increased obviously after treatment in both the observation group and the control group, there were pronounced improvements on physiological function, pain, physical activity, social function and affection function in the observation group (all P < 0.05).

CONCLUSIONThe quality of life for female stress urinary incontinence patients may be poor, however the dog-day acupuncture and tortoise-shell moxibustion combined with pelvic floor muscle exercises can improve the symptoms of urinary incontinence and increase the quality of life of patients.

Acupuncture Therapy ; Adult ; Aged ; Exercise Therapy ; Female ; Humans ; Middle Aged ; Moxibustion ; Muscle Contraction ; Muscles ; physiopathology ; Treatment Outcome ; Urinary Incontinence, Stress ; physiopathology ; therapy

OBJECTIVETo explore the effects of integrative medicine (IM) rehabilitation protocolon motor function, activity of daily living, and quality of life (QOL) in hemiplegia patients after stroke.

METHODSTotally 120 patients with post-stroke hemiplegia were allocated to four groups using sealed envalope drawing, i.e., the rehabilitation group, the Chinese medical treatment group, the acupuncture group, and the comprehensive rehabilitation group, 30 cases in each group. Based on routine rehabilitative training, patients in the Chinese medical treatment group, the acupuncture group, and the compre-hensive rehabilitation group received standardized treatment based on syndrome typing, Shi's Consciousness-Restoring Resuscitation acupuncture, Chinese herbs + acupuncture comprehensive rehabilitatino protocol, respectively. The treatmet cycle consisted of 4 weeks with 24-week follow-ups. Fugl-Meyer motor assessment (FMA), Modified Barthel Index (MBI), and Stroke-Specific Quality of Life Scale(SS-QQL), and safety assessment were taken as main effect indices before treatment, at week 4 of treatment, at week 12 and 24 of follow-ups, respectively.

RESULTSThere was no statistical difference in FMA score, MBI score, SS-QOL score among the four groups before treatment (P > 0.05). These scores were significantly improved in the four groups at week 4 of treatment, week 12 and 24 of follow-ups, respectively (P < 0.05). Besides, FMA score and SS-QOL score were significantly improved in the comprehensive rehabilitation group at each corresponding time point, as compared with other treatment groups (P < 0.05).

CONCLUSIONSThe comprehensive protocol could significantly improve motor function, activity of daily living in hemiplegia patients after stroke, and further improve their QOL. Its effect was better than other single treatment.

Activities of Daily Living ; Acupuncture Therapy ; Hemiplegia ; rehabilitation ; Humans ; Integrative Medicine ; methods ; Medicine, Chinese Traditional ; Motor Skills ; Quality of Life ; Stroke Rehabilitation ; Treatment Outcome

The in-depth improvement of medical treatment is particularly important for the integrity, systema-ticity and synergy of the reform. Through the theoretical analysis of physician's incentive expectation, it was found that the doctor's behavior is continuously affected by the three pairs of motivational relationships, and the interrupted or distorted incentive relationship is not conducive to guiding the reasonable service delivery from physicians. In these three pairs of incentive relationship, the two reforms of medical insurance payment system and physician's salary system occupy an important position, and their degree of correlation is extremely high. Only when the two are effectively synergistic can the incentive compatibility" of public medical institutions and physicians be realized to achieve the expected results. The goal of is to make a change in the physician's behavior as expected by the health system in the reform.

BACKGROUNDIt is generally accepted that gliomas are the most common primary brain tumors with poor prognosis. We aimed to explore the relationship of the immunity of the central nervous system and the genesis and development of glioma.

METHODSG422 glioma was implanted in the brain of BALB/c mice (immuno-competent mice), nude mice (T cell related immuno-deficient) and complement C3 knock-out mice (complement C3 related immunodeficient). The survival time of the host, growth and histopathology of the tumor, and concentrations of tumor necrosis factor-α (TNF-α) and interferon-γ (INF-γ) in tumor tissues were assessed.

RESULTSTumor spheres were formed in all mice after injection, and glial fibrillary acidic protein (GFAP) positive staining of the cells declared their glioma origin. The longest median survival time of (44.3 ± 6.0) days was found in BALB/c mice, followed by (24.8 ± 5.2) days in nude mice and the shortest (18.6 ± 5.8) days in complement C3 knock-out mice. Accordingly, the growth of the tumor was fastest in complement C3 knock-out mice, followed by the nude mice and slowest in the BALB/c mice. Although the proportions of infiltrating CD68(+) lymphocytes in tumor tissues showed no significant difference (P > 0.05), TNF-α level in the nude and C3 knock-out mice, (28.11 ± 4.86) µmol/L and (22.87 ± 6.36) µmol/L respectively, were significantly lower (P < 0.01) than that in the BALB/c mice, which was (230.21 ± 39.17) µmol/L. The INF-γ level was highest in the BALB/c mice ((180.76 ± 29.19) µmol/L), followed by the nude mice ((113.46 ± 23.76) µmol/L) and then the C3 knock-out mice ((16.84 ± 4.45) µmol/L).

CONCLUSIONSThe G422 glioma implanted in the brains of mice with different immune ability would be a useful model for studying the relationship of the immune system and tumor in the central nervous system. Furthermore, the T cells and complement C3 compartments of the immune response may affect the growth of implanted tumors and inflammatory factors such as TNF-α and INF-γ.

Animals ; Antigens, CD ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; Brain Neoplasms ; genetics ; metabolism ; Cell Line, Tumor ; Complement C3 ; genetics ; metabolism ; Glioma ; metabolism ; pathology ; Interferon-gamma ; metabolism ; Mice ; Mice, Inbred BALB C ; Mice, Knockout ; Mice, Nude ; Tumor Necrosis Factor-alpha ; metabolism

Objective To study the fundus diseases that primary and middle school students may be susceptible to suffer, and to understand the prevalence rate and constituent ratio of these diseases. Methods A total of 9 504 students were examined from November 2015 to February 2017 to find out their ocular fundus conditions. They were from all the primary and secondary schools directly subordinate to Dagang Oilfield headquarters. Among the 9 504 participants 4 998 were male and 4 506 were female,with the age span of 5 to 23 and the average age of(13.40±3.41).Our medical examination included uncorrected visual acuity examination and fundus oculi photography. The distribution of fundus diseases was analyzed,including gender,vision acuity and age composition of patients with major diseases. Results Among the 9 504 students,4 314 had emmetropic eyes,and 5 190 had refractive errors.A total of 9 126 out of the 9 504 examined students had normal ocular fundus(96.02%),while those with abnormal ocular fundus accounted for 378(3.98%).The main types of abnormal ocular fundus included the tessellation fundus 354 (3.72%), followed by the large depression of optic disk 16 (0.17%). Among all the 354 cases with tessellation fundus, 179 were male and 175 were female. There were 257 students whose visual acuity≤0.3/0.3,and the prevalence was higher in 17-19 years old students(5.86%).Conclusion It has been revealed in this epidemiological survey that the main abnormal ocular fundus of primary and middle school students in Dagang is tessellation fundus.Most of the tessellation fundus are caused by middle and high myopia,and very few are found in emmetropic students. It has also been found that the incidence of tessellation fundus increases significantly with the increase of age. The large depression of optic disk ranks the second in the abnormal ocular fundus, which is mostly physiological.

Background The prevalence of chronic kidney disease (CKD) and prediabetes has increased in China,and at different rates in different locations.Therefore a community-based screening research was conducted in order to determine the prevalence of CKD and prediabetes,and to analyze associated risk factors of CKD and prediabetes in a city of Southern China.Methods A total of 7801 community residents aged 18 year and older from 6 communities were screened by a stratified random cluster sampling method.An estimated glomerular filtration rate (eGFR),albuminuria,fasting plasma glucose (FPG),and homeostatic model assessment of insulin resistance (HOMA-IR) were measured.Age-standardized prevalence was calculated by the direct method with the use of data on the population distribution in China in 2006.Multivariate logistic analysis was used to analyze the risk factors of CKD and prediabetes,and association of insulin resistance (IR) with CKD and prediabetes was analyzed.Results The age-standardized prevalence of CKD was 12.5％,eGFR ＜60 ml.min-1.1.73 m-2 was 2.7％ and ACR (albumin to creatinine ratio) ＞30 mg/g was 10.3％.The age-standardized prevalence of prediabetes was 12.1％.Logistic regression suggests that IR was a common independent risk factor of CKD and prediabetes.Further analysis show that HOMA-IR was increased with the aggravation of kidney injury and FPG.Conclusion CKD and prediabetes have become a major public health problem in Zhuhai,Southern China; insulin resistance may be an important risk factor.

Objective To investigate the influencing factore of aflatoxin B1 (AFB1) exposure in healthy people who lived in aflatoxin high-exposure area and to provide a basis for preventing AFB1 exposure. Methods To the residents lived in the city of Nanning in Cuangxi Province, a questionnaire survey was used to acquaint relevant information. The AFB1-albumin adducts (AAA) levels were screened by enzyme-linked immunosorbent assay and the liver function detected using a Bekman LX20 Chemistry Analyzer and diagnostic agents from Randox, UK. Results AAA level was significantly higher (P<0.05) in the people with lowincome, having habits of smoking, drinking, eating bulk rice, and eating rice that had been saved for a time of more than 30 days, and keeping regularly dining out. Conclusions The level of income and the lifestyle are related with Aflatoxin Bl exposure. The risk factors about Aflatoxin Bl exposure include consumption of bulk rice, regularly dining out, and drinking.