Objective:To develop a remote training system for CT simulation positioning of radiotherapy using virtual reality technology, and to explore a new method of medical training.Methods:The 3DMax and Maya were employed to establish the 3D model. The unity3D engine was adopted to develop 3D virtual operation and interaction system. Java spring MVC architecture was utilized as the system background service. MySQL was used as the background database system. The users were assigned into two roles: teacher and student, and the modes were divided into teaching and assessment modes.Results:The function of the system covered the whole process of CT simulation positioning, mainly including modules of patient information management, CT simulation positioning machine cognition, body position fixation technology, CT positioning scanning, and emergency handling, etc. Since it was put into use in 2018, the system has been running stably, with 14 920 pages views and an 86.66% pass rate. Compared with the traditional training, the training efficiency has been significantly improved and has received unanimous recognition.Conclusions:The remote training system can effectively improve the clinical practice ability and humanistic care ability of the trainees, which has good autonomy, sharing, and innovation. At present, the system has been put online and has strong popularization with prospects for broad application.

Objective To analyze the effect of the new conformal index(nCI)and the conventional conformal index(CI)on the treament planning quality of lung stereotopic radiotherapy(SBRT).Methods A total of 19 peripheral lung cancer patients,treated with SBRT in Fujian Medical University Union Hospital from 2014 to 2017,were analyzed retrospectively.Each patient was planned twice yielding identical CI and nCI.The prescription to 95％of planning target volume(PTV)was 48 Gy in four fractions,and renormalization was performed when needed for nineteen nCI plans.The Wilcoxon signed-rank test was used to examine the dosimetric index.Results The dose conformity plots indicate that nCI does not only reflect the dose to the organ at risk outside tumor,but also represents the dose distribution in the PTV.In addition,nCI was stricter with treatment planning qualities when the dose around PTV was closer to the prescribed dose.The value of target coverage(TC),the ratio of out-of-target volumes receiving 105％prescribed dose to the target volume(R105％),the ratio of volume covered by 50％isodose line to the target volume(R50％),and the ipsilateral lung V20were 98.70％,0.56,5.53,15.59％in the CI plans,vs.90％,0,4.99,14.42％in the corresponding nCI plans,respectively.All index were significantly lower in the nCI group(Z ＝-3.823,-3.180,-3.823,-3.783,respectively,P＜0.05).The ratio of the maximum dose to the 2 cm external margin from the PTV(D2 cm)to the maximum dose to the PTV were 63.70％and 64.07％respectively in the two groups,and the differences were not statistially significant(P＞0.05).The conformity values denoted a clinically favorable value as 1 between D95％and D99％of nCI plans,yet were not applicable to CI plans.Conclusions It is more clinically relavant to evaluate lung SBRT plans using nCI,TC and other indicators collectively than using CI alone.

Objective To investigate the dosimetric performance of two algorithms for correcting the presence of tissue inhomogeneities,the finite site pencil beam (FSPB) and X-ray voxel Monte Carlo (XVMC) plans were implemented in the MONACO system,with the accuracy of application to clinic treatment of two algorithms were evaluated.Methods In a non-uniform artificial anthropomorphic phantom,regular open fields and intensity modulation radiated therapy (IMRT) plans of the MONACO were measured by using calibrated EBT2 films,and the dose accuracy of the two kinds of plans was analyzed by comparing the planned and measured plane dose.Results In an anthropomorphic phantom,the deviations between the calculated values by XVMC and the measured values by films were less than ± 2％.While the deviations of FSPB values between calculation and measurements was within ± 3％,except at the condition of 15 MV,10 cm ×2 cm field,the dose error in lung was up to 6.51％.The verification of individual IMRT beams based on films showed that the pass rates of calculation by XVMC and FSPB were larger than 90％ with γ criterion of 3％/3 mm and 4％/4 mm,respectively.At 3％/3 mm,the pass rates of FSPB were in the range of 80％-90％.At the same time,the pass rates of all individual fields were higher than 90％.Conclusions The accuracy of dose calculation of XVMC is better than that of FSPB when being in multi-segments and non-uniform media.The error of algorithm can be controlled within ±3％,for the calculation by XVMC.And the dose deficiency of PTV arising from algorithm can be avoided.

Objective To analyze the epidemiological characteristics of the severe cases of hand , foot and mouth disease ( HFMD) in Danzhou and to provide a scientific evidence for the prevention of severe HFMD.Methods Descriptive epidemiological analysis was used to analyze the characteristics of severe ca -ses of HFMD occurred from 2010 to 2014 .Results A total of 18 960 cases of HFMD were reported in Danzhou City from 2010 to 2014.The death rate (annual deaths/1000 persons) was 0.13%.One hundred and eighty-eight cases (0.99%) were diagnosed as severe HFMD with a male to female ratio of 2.4 :1 and 96.28%of them were scattered inhabiting children .Six cases were died from severe HFMD and all of them were under 2 years of age.In total 87.77%of the severe cases were occurred in children under 2 years of age.The severe cases were mainly occurred in June and July .Children form the countryside showed higher rates of severe HFMD than those from cities and towns .No significant differences in the time between the in-itial diagnosis and treatment for children with HFMD in countryside and urban areas were found .However , the differences in the duration from initial diagnosis to severe HFMD between children in countryside and ur -ban areas were statistically significant (M-W test, P<0.05).Among the 188 severe cases, 82.44% were initially diagnosed as common HFMD cases by the county-level medical institutions and 90.96%were diag-nosed as severe cases by the municipal and above medical institutions .The cases positive for EV71 strains accounted for 44.15%.Conclusion Most of the severe HFMD were developed in scattered inhabiting chil-dren under 2 years of age in the countryside of Danzhou during 2010 to 2014.In order to decrease the mor-bidity and mortality of severe HFMD in children , it is necessary to implement health education for residents , to improve the professional skills of medical staffs in the early diagnosis of HFMD , and to strengthen etiologi-cal surveillances and warning system for HFMD .

Objective To investigate the relationship between the neuroprotective effect of epigallocatechin gallate ( EGCG ) for PC12 cells induced by 1-methyl-4-phenyl-pyridinium ( MPP+ ) and activating nuclear factor-related factor 2 ( NRF2 ).Methods Well differentiated PC12 cells treated with MPP+ were used as the in vitro cell models,and PC12 cells were pretreated with different concentrations of EGCG.MTT assay was used to investigate the cell viability.Western blot was used to observe the expression of NRF2 in cells and distribution in the nucleus and the cytoplasm.Real-time PCR was used to observe the antioxidant enzymes,HO-1 and NQO1 mRNA expression.Results Pretreatment of PC12 cells with different concentrations of EG CG for an hour could restore cell viability.Western blot showed that expression of NRF2 in cells treated with MPP+ for 24 hours was increased 148％ +5％ compared with the control group (t =6.102,P ＜0.01 ).The level of NRF2 in EGCG pretreated group was 188％ + 6％ compared with the control group(t =11.172,P ＜0.01 ).Moreover the NRF2 protein level in the nuclear was also increased.Western blot showed that the NRF2 protein level in the nuclear was 258％ +2％ compared with the control group (t =21.995,P ＜ 0.01 ).Further research found U 120,an inhibitor of ERK,could inhibit the effect of EGCG.The levels of NRF2 in both samples were 148％ ± 15％ and 158％ ± 1％ compared with their respective control groups(t =6.118,8.058,both P ＜0.01 ).In accordance with the NRF2 data,real-time PCR indicated that the levels of HO-1 and NQO1 mRNA expression increased obviously in the group pretreated with EGCG.Likewise,U120 could also inhibit HO-1 and NQO1 mRNA expression induced by EGCG.Conclusions EGCG can repair oxidative damage to PC12 cells induced by MPP+.The protective effect may be related through the ways to activate ERK-NRF2 and induce downstream of antioxidant enzyme expression,such as HO-1 and NQO1.

Objective To evaluate the safety and efficacy of Zonisamide(ZNS) as adjunctive therapy in patients with refractory partial seizures receiving other antiepileptic drags (AEDs).Methods This was a randomized,double-blind,placebo-controlled study conducted at multi-centers.All 240 subjects were randomized to either the ZNS group or the placebo group in a 1:1 ratio.The double-blind treatment phase included a titration phase during which zonisamide dose inereased from 100 mg/day to 300 mg/day over 4 weeks and then a 12-week fixed-dose phase.The primary efficacy endpoint was,the median % reduction from baseline in all pattial seizure frequency(CPS+SPS+SGS)during the fixed-dose phase.The important secondaw endpoint wag the responder rate.Safety profiles and tolerance were also evaluated.Results The FAS analysis showed the median reduction from baseline in the ZNS group was greater than in the placebo group(48.4%vs 26.6%),the difference was significant for ZNS compared with placebo(F=4.904,P=0.028);The responder rates for all partial seizures(48.6%vs34.9%,X2=4.046,P=0.044)and for complex seizures(52.2% vs 33.3%,X2=5.607,P=0.018)were significantly higber in the ZNS group than in the placebo group in the FAS population.The overall adverse events(AEs)profile was comparable between the two groups.The most frequent AEs considered to be related to zonisamide by the investigator were headache,dizziness,somnolence,anorexia,nausea,etc.Conclusions ZNS is superior to placebo in reducing the frequency of partial seizures and well-tolerated.ZNS could be a choice of adjunctive therapy in patients with refractory partial seizures.

Objective: To quantify the effect of motor-developmental Tuina therapy on 61children with cerebral palsy. Methods: All the children received the motor-developmental Tuina therapy for 20 min each time, 3 to 6 times per week. The gross motor functions of the children were evaluated by GMFM 66. The baseline period evaluations in 15 children and follow-up period evaluations in 26 children were performed. Results: GMFM 66 score significantly increased at the end of treatment period (P<0.001). The GMFM 66 score changes per month in treatment period was significantly greater than those of both baseline period and follow-up period (P<0.001). Conclusion: The effect of motor-developmental Tuina therapy was notable on children with cerebral palsy. Continuous progress of the gross motor functions in these children may be obtained by continuous therapy.

Objective To observe and evaluate the clinical efficiency and safety of topiramate for treatment of patients with various types of epilepsy Methods 142 patients suffering from epilepsy were underwent the treatment of topiramate, of them 93 cases received a to piramate add on therapy and 49 cases a monotherapy The efficiency and side effects were evaluated after 8 weeks titration period and 12 weeks stabilization period Results The total effective rate was 79% and 84% in add on group and monotherapy group respectively The seizure free rate was 28% and 41% in two groups respectively The optimal dosages were 100～200 mg/d in adults and 3～5 mg/d in children Side effects were generally mild Conclusion Topiramate is a highly effective, safe and widespread first line antiepileptic drug which can be used as a monotherapy or add on treatment

Objective: To investigate validities of MMPI- 2 measures of general maladjustment in people who had expe- rienced traumatic events. Methods: Participants were 43 patients with stress disorder (SD) and 44 well- adjusted trauma survivors(TS). Validities of 7 MMPI- 2 measures of general maladjustment were compared with the mean scores on 8 clini- cal scales (M8), which were considered as the criterion measure of general maladjustment. Results: Patients with SD ob- tained significantly higher scores on 6 measures and M8 than TS. Most of the measures were significantly related to M8 in both groups. Although F and PK sometimes added significantly to the variance accounting for the criterion measure, Pt added significantly and meaningfully to each of the other MMPI- 2 measure in predicting maladjustment. Conclusion: The results support the use of the MMPI- 2 as a measure of general maladjustment in trauma survivors. Pt emerges consistently as a good indicator of general maladjustment.

We reviewed 100 cases with Guillain-Barré syndrome (GBS) from 1980 to 1999, and found that the features of GBS in electrophysiological classification, age, area, seasonal distributions, and in preceding illness in northwestern China are different in some aspects from those in Europe and North America or in northern China. The demyelinating pattern appeares as a major subtype not only in different age groups, but also in different test times after symptom onset.