The etiology of reversible posterior leukoencephalopathy syndrome(RPLS)is more complex.Its pathogenesis has a lot of controversies,and its clinical manifestations are headache, nausea,vomiting,epileptic seizure,consciousness disturbance and visual abnormality.Neuroim- aging examinations have shown that diffuse symmetrical white matter edema is predominantly in the bilateral posterior brain regions.Clinical symptoms and neuroimaging changes can be recov- ered completely after timely and effective treatment.If the treatment is delayed,it may compli- cate with cerebral infarction or hemorrhage,and lead to irreversible damage.

Objective To analyze the normal lung dose-volume histogram(DVH) varieties in the former and later period(P1 and P2)of three dimensional conformal radiation therapy(3DCRT) plans and the compound (Pc) plan in non-small cell lung cancer(NSCLC),and to access the feasibility to modify the target volume during the treatment course.Methods Twenty-one NSCLC patients who had received accelerated hyper-frationation 3DCRT in P2 were included in the study.Both of the P1 and P2 plans were redesigned to a total dose of 70 Gy with V20 smaller than 35%.When the target volume was modified and P2 plan was rede signed using accelerated hyper-frationation 3DCRT of 30 Gy after P1 plan of 40 Gy,the Pc plan was compoun ded by transmitting the parameters(such as target volume,irradiation field and dose) of P1 plan into P2 plan. Total lung volume and target volumes(GTV,PTV) of P1 and P2 were evaluated.MLD,V5,V10,V20 and V30 of P1,P2 and Pc were calculated.Results The total lung volume in P1 and P2 plans was not significantly dif ferent(t = 0.19,P = 0.850).The volumes of GTV,PTV in P2 were obviously smaller than P1 (t = 2.88,P = 0.009 ; t = 4.01 ,P = 0.001) .When comparing P2 with P1 ,MLD were 16.5 Gy Vs 17.8 Gy (t = 2.60, DOI:10.3760/cma.j.issn.1004-4221.2009.01.057 P = 0.017),V30 was significantly decreased (t = 2.19,P = 0.041),but V5,V10 and V20 had no significant difference.Similar differences were found in MLD,V5 ,V10 ,V20 and V30 when comparing Po to P1.P2 plans had significantly smaller MLD,Vs,V10,V20 and V30 than Pc plans.Fourteen patients with decreased PTV were further analyzed.The V30 and MLD decreased significantly (t = 3.00,P = 0.0 I 0;t = 2.38,P = 0.033), but V5 ,V10,V20 had no difference when comparing P1 and P2 plans.Among these 14 patients,the V10 and V30 decreased significantly(t = 2.76,P = 0.033 ; t = 3.60,P = 0.011) when P2 plans were generated using the same field number and beam angles in P1 plans in 7 patients.The parameters were similar in P1and Pc plans,but increased significantly when comparing to P2.Various parameters were the same among P1,P2 and Pc plans when P2 plans were designed using 1-2 different fields and angles in the other 7 patients.The differ ences were not significant between P1 and P2 plans in 7 patients with the same or increased PTV.Expansion or contraction of PTV significantly influenced MLD and V2o (r =-0.62,P = 0.03 ; r = O.48,P = 0.029). Conclusions When the tumor regresses,the high dose volume of the lung decreases with modifying the tar get volume and replanning in the later period using accelerated hyper-frationation 3DCRT.The low dose vol ume of the lung may decrease if the field orientations are same throughout the treatment.It is rational to eval uate the normal lung DVH of the whole plan when the physical parameters of the later period plan are the same as the former one.

Objective To learn about the state of anxiety, related factors and demand of the family members of youngster patients with eye traumas during the operations, to improve the quality of nursing care by effectively relieve the anxiety of family memebers through appropriate intervention. Methods The anxiety and needs of family members of 148 children patients with eye traumas were investigated during the perioperative period with self-rating anxiety scale and self-designed questionnaires, and appropriate nursing was given according to the survey results. Results The anxiety score of family members was (56.93 ± 14.72), which was at higher level when the patients were just admitted. The scores statistically de creased after nursing care. The anxiety was related to factors such as the security and the effect of the operation, the technical level of the surgeon, the anesthesia method (general anesthesia),the age of the children patients and the emergency operation. Conclusions Nursing staff can effectively relieve the anxiety of the family members of children patients during perioperative period by supplying special care according to their different demands.

AlM:To investigate the features on prolonged central serous chorioretinopathy ( CSCR ) by optical coherent tomography ( OCT ) and to provide the basis of deciding the pathogenetic condition and prognosis. METHODS: Eighty - five patients who had been diagnosed with CSCR were grouped by suffering time as below: 32 patients suffered longer than 6mo as the prolonged and 53 patients with CSCR cured within that time. The imaging features of OCT were compared between the above groups.RESULTS:The incidence rate of neuroepithelial serous detachment extent above 500μm associated with pigmentary epithelial detachment in suffering eye and pigmentary epithelial damage in contralateral eye was significantly different between two groups. However, the incidence rate of neuroepithelial serous detachment extent above 4 000μm was not significant difference.CONCLUSlON:OCT could display clearly the change of every layer of retina with simplicity and visibility, which supplies us a new horizon to diagnose and trace CSCR. We could decide the pathogenetic condition and prognosis in accordance with the features of OCT, to provide references for the diagnosis and treatment of CSCR.

Objectives:To introduce a new calibration protocol for clinical reference dosimetry of high energy electron beams published by Radiation Therapy Task Group 51, American Association of Physicists in Medicine. Methods:According to the new protocol, measuring the absorbed dose of 5, 6, 7, 9, 10 and 12 MeV Electrons produced by the Siemens M6740 accelerator of our hospital with the help of the Capintec-192 electrometer and PR 06C chamber. Results:For 7-12 MeV, the discrepancies vary from -0.1% to 0.7% between TG 51 and TG 21, and from -0.3% to 0.4% between TG 51 and JJG1026 91. For 5 and 6 MeV, there are 1.7% and 1.5% discrepancies between TG 51 and TG 21, and -1.6% and 1.7% between TG 51 and JJG1026 91. Conclusions:The new protocol is more accurate and convenient because of its precise rationale and concise formulae.

Objective To study epidemiology, clinical findings, diagnosis and treatment of sepsis caused by Vibrio vulnificus. Method Patientss with Vibrio vulnificus sepsis were collected from 1995 to 2008. The medical records including epidemiological and clinical data were analyzed. Results The male-to-female ratio of 34cases was 4.7:1 and 76. 5% of these patients suffered from chronic liver disease. Most patients occurred from April to October with signs of abrupt fever, characteristic cutaneous lesions, hypotension and progressive multiple organ disfunction syndrome (MODS). The mortality was over 47.1% . The criteria proposed for early diagnosis of Vibrio vulnificus sepsis were abrupt onset with fever during the period from April to November, characteristic cutaneous lesions, such as the most commonly occurred haemorrhagic bullae on the extremities or even extensive necrosis of skin and muscular tissue, progressive hypotension or shock accompanied by MODS, pre-existing liver disease or chronic abuse of alcohol, and consumption of raw seafood or exposure to seawater within 12 week. Early administration of the third-generation cephalosporins with the quinolones in full dosage, aggressive wound debridement,appropriate dermoplasty and supportive care contribute to a better outcome. Conclusions Vibrio vulnificus sepsis progresses rapidly with high mortality. Early diagnosis, rapid treatment with prompt antibiotics and aggressive surgery treatment are very important to improve the outcome.

Objective To analyse the effects of serum estradiol levels during controlled ovarian hyperstimulation (COH) on the outcomes of in vitro fertilization and embryo transfer (IVF-ET). Methods The clinical data of 472 patients undergoing IVF-ET with GnRH analogues recombinant FSH long protocol were retrospectively analysed. The area under the curve (AUC) of estradiol (E2) level was calculated during COH, and patients were categorized into groups according to the percentile of AUC of E2(AUCE2) during COH. The general characteristics and parameters related to the outcomes of IVF-ET were compared among groups. Results The 10th percentile and 90th percentile of AUCE2 were 3 347.0 pmoL/L and 14 414.3 pmol/L, respectively. Four hundred and seventy-two patients were divided into lower reaction group (AUCE2 3 347.0 pmol/L, n=48), normal reaction group (14 414.3 pmol/L>AUCE2 > 3 347.0 pmol/L, n=376) and higher reaction group (AUCE2≥14 413.3 pmol/L, n=48). There was no significant difference in age, body mass index, baseline follicle stimulating hormone level, time of treatment with gonadotropin, endometrium thickness on day of transfer and embryos transferred(P>0.05). Compared with lower reaction group and normal reaction group, the number of oocytes per retrieval and number of embryos frozen were significantly larger(P<0.01) and the mild/severe ovarian hyperstimulation syndrome rate was significantly higher in higher reaction group(P<0.05). There was no significant difference in fertilization rate, cumulative embryo score, high-grade embryo rate, clinical pregnancy rate and implantation rate among groups (P> 0.05). Conclusion Sustained snpraphysiological serum E2 levels during the COH process do not adversely affect the quality of oocytes and embryos, clinical pregnancy rate and implantation rate to some extent in IVF-ET.

Chronic osteomyelitis is one of the most common disorder in clinic. In recent years due to diabetes, peripheral vascular disease and trauma induced disease increased, the prevalence rate increased. With the development of magnetic resonance imaging and CT imaging technology, it greatly improved the accuracy of clinical diagnosis of chronic osteomyclitis and ability to describe the infection characteristics, and provide a reliable basis for clinical treatment. The current research on chronic osteomyelitis mainly concentrated on the aspects of imaging applications and ways of using antibiotic optimization control inflammation, defect restoration and reconstruction of blood supply and treatment. But the best time to the antibiotic therapy and the use of program is still uncertain, for after debridement, bone grafting time and defect repair function of fast recovery still need further research.
Anti-Bacterial Agents ; therapeutic use ; Chronic Disease ; Humans ; Osteomyelitis ; diagnosis ; therapy

Objective To discuss the value of digital tomosynthesis for detection of pulmonary nodules. Methods Thirty patients suspected of having pulmonary nodules underwent chest radiography, digital tomosynthesis and CT examination. Above image data were transferred to postprocessing work station and were reviewed by 2 radiologists with 3 years of chest-radiology diagnosis experience in a double-blind method. The number, location and size of nodules were recorded. Then, 2 radiologists reviewed the all images once more, and discuss in consensus. The sensitivities of chest radiography and digital tomosynthesis for detection of pulmonary nodules were respectively calculated according to the CT results. Chi-square test was used for radiography, digital tomosynthesis and CT examination. Results Of 30 patients, 21 were detected having pulmonary nodules by X-ray radiography and 9 were negative, the total number of 40 nodules was detected, while 89 nodules in 26 patients were detected by digital tomosynthesis, and only 4 patients were negative. CT demonstrated 102 nodules in 27 patients, and 3 patients were negative. Taking CT as "gold standard", the sensitivities of X-ray radiography and digital tomosynthesis were 27.4%(28/102)and 87.2%(89/102), X~2=4.35, P<0.05, respectively. Conclusion Digital tomosynthesis has a high sensitivity for detection of pulmonary nodules compared with X-ray radiography, and could be an excellent and necessary supplementary technique of X-ray radiography.

Objective To develop a clinical laboratory vehicle with advantages in mobility,deployment,automation and informatization to meet the requirements of disaster relief.Methods Ford transit V348 ambulance was used as the base,which was equipped with routine blood analyzer,routine urine analyzer,biochemical analyzer and etc.The same instruments,agents and procedures were adopted as those in the clinical laboratory department of rear hospital,and LIS,air cleaning system and necessary auxiliary units were also involved in the modification.Results The clinical laboratory vehicle increased the working efficiency while decreased the errors.Conclusion The vehicle fulfills mobile medical support for military operations other than war such as disaster relief,and thus is worthy promoting practically.