Objective:To investigate the dosimetric differences in volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) in patients receiving adjuvant radiotherapy and internal lymph node irradiation after left-sided modified radical mastectomy.Methods:VMAT and IMRT radiotherapy plans were established for 20 patients undergoing left-sided modified radical mastectomy. The dosimetric parameters of the target area and organs at risk were calculated by the dose volume histogram. The categorical variables were tested by χ2 or Fisher′ s exact probability test. The continuous variables with normal distribution were analyzed by paired-t test or rank-sum test. Results:Among the two radiotherapy techniques, the homogeneity index of IMRT was significantly higher than that of VMAT ( P<0.05). The time of VMAT treatment was significantly shorter than that of IMRT ( P<0.01). VMAT was superior to IMRT in V 20Gy and V 30Gy of the affected lung (both P<0.05). VMAT was superior to IMRT in the left anterior descending coronary artery D mean, D max, and heart V 30Gy, V 40Gy, D mean and D max(all P<0.01). The esophageal D mean in the VMAT group was superior to that in the IMRT group ( P<0.05). The V 5Gy and V 10Gy of the contralateral lung and the D max of the esophagus in the IMRT group were significantly better compared with those in the VMAT group (all P<0.05). Conclusions:VMAT can significantly reduce the dose of the heart, contralateral lung, spinal cord, esophagus and other vital organs, and shorten the treatment time. For patients who need adjuvant radiotherapy and internal mammary lymph node irradiation after left-sided modified radical mastectomy, VMAT technology can better protect normal tissues than IMRT.

Objective: To investigate the value of MR unenhancement and dynamic enhancement scans for distinguishing non-hypervascular pancreatic neuroendocrine tumor (PNET) from pancreatic ductal adenocarcinoma (PDAC). Methods: Thirty five patients (45 lesions) with pathologically confirmed PNETs and 52 patients (53 lesions) with PDACs were retrospectively analyzed before surgery. All patients underwent MR unenhanced and dynamic enhanced scans (including arterial, venous and delayed phase). Based on arterial enhancement, PNETs were divided into hypervascular and non-hypervascular lesions. The morphologic characteristics (including location, size, quantity, margin and signal intensity) and enhancement patterns of non-hypervascular PNETs and PDACs were evaluated. Involvement of the pancreatic duct and bile duct, vascular invasion, peripancreatic infiltration and other organs metastasis were observed. Independent sample ttest was used to compare signal intensity ratio of nonhypervascular PNET and PDAC. Chi-square test was used to compare MRI characteristic and secondary signs. Results: PNET included 20 hypervascular and 25 nonhypervascular lesions. Enhancement degree of non-hypervascular PNET was higher than PDAC in the arterial, venous and delayed phase (P<0.01). Non-hypervascular PNET showed significantly higher frequencies (P<0.01) of venous hyper-or isoenhancement (20/25), delayed hyper-or isoenhancement (23/25) and a well-defined margin (17/25), but lower frequencies of ductal stricture and dilatation (P<0.01), pancreas atrophy (P<0.05), bile duct stricture (2/25), peripancreatic infiltration (8/25, P<0.01) and vascular invasion (8/25, P<0.05), when compared with PDAC. Conclusion A well-defined margin, hyper-or isoenhancement in the venous and delayed phase,and without ductal dilatation and pancreas atrophy are more common in non-hypervascular PNET, which may be distinguished from PDAC.

Objective: To investigate the clinical efficacy of enhanced recovery after surgery(ERAS) in atrial caval shunting (ACS) for type Ⅱ Budd-Chiari syndrome(BCS). Methods: The clinical data of patients underwent ACS for type Ⅱ BCS in the Henan Province People′s Hospital from January 2014 to June 2016 were prospectively analyzed.Randomized and single-blind, controlled study was performed among the patients, and all of them underwent ACS and were divided into control group (patients underwent traditional perioperative management) and ERAS group (patients underwent ERAS perioperative management) based on a random number table.Operational and postoperative data, levels of inflammatory cytokines, stress state evaluation and postoperative complications were observed.The comparison between the two groups was evaluated with an independent sample t test.The trend analyses for variables were done using repeated measures ANOVA.The count data were analyzed using the chi-square test or Fisher exact. Results: Eighty-two patients were screened for eligibility, and allocated into the control group (40 patients) and the ERAS group (42 patients). All patients underwent ACS successfully with no death.Comparison of intraoperative status: operation time, volume of intraoperative blood and number of patients receiving blood transfusion were (211.0±12.9) minutes vs. (207.7±10.7) minutes, (167.5±28.3) ml vs. (165.0±28.4) ml and 3 cases vs. 1 case between the control group and the ERAS group, respectively, showing no difference between the two groups (t=0.90, 0.29, χ²=0.32, all P>0.05). Comparison of postoperative status: time of gastric tube removal, time of catheter removal, time of chest tube, time to flatus, time of food intake, duration of postoperative infusion, duration of postoperative hospital stay and numeric rating scale were (3.7±0.5)days vs. (0.0±0.0)days, (2.3±0.7)days vs. (1.4±0.5)days, (3.7±0.7)days vs. (2.3±0.5)days, (75.2±3.8)hours vs. (46.6±4.2)hours, (75.7±4.7)hours vs. (21.4±2.1)hours, (10.0±1.0)days vs. (5.8±0.9)days, (11.4±1.0)days vs. (7.8±0.6)days, 2.9±0.4 vs. 1.9±0.6 between the control group and the ERAS group, respectively, with statistically differences (t=35.03, 4.36, 8.10, 22.89, 47.78, 14.75, 14.22, 6.13, all P<0.05). Stress state evaluation: the levels of IR were (2.7±0.1) vs.(2.7±0.1), (8.8±0.7) vs. (5.2±0.3), (11.0±0.5) vs. (7.3±0.5), (4.9±0.2) vs. (3.9±0.1), and the levels of C-reaction protein were (14.6±1.3)mg/L vs.(14.6±1.1) mg/L, (101.2±13.6) mg/L vs. (89.5±6.9) mg/L, (62.7±8.6) mg/L vs. (56.4±8.4) mg/L, (46.4±6.7) mg/L vs. (40.0±5.6) mg/L from pre-operation to postoperative day 1, 3 and 5 between the control group and the ERAS group, respectively, with statistically significant differences in changing trends(F=136.61, 4.97, both P<0.05). Comparisons of levels of inflammatory cytokines: the levels of IL-6 were (43.1±2.7) ng/L vs. (43.6±3.6) ng/L, (135.1±6.4) ng/L vs. (117.4±5.7) ng/L, (145.4±6.7) ng/L vs. (128.5±5.5) ng/L, (93.3±3.7) ng/L vs. (88.0±3.9) ng/L, and the levels of TNF-α were (10.4±0.3)mmol/L vs. (10.4±0.3) mmol/L, (14.4±0.4) mmol/L vs. (12.6±0.4) mmol/L, (15.6±0.4) mmol/L vs. (13.8±0.4) mmol/L, (12.3±0.7) mmol/L vs. (11.4±0.6) mmol/L from pre-operation to postoperative day 1, 3 and 5 between the control group and the ERAS group, respectively, with statistically significant differences in changing trends (F=15.15, 21.45, both P<0.05). Comparison of postoperative complications: incidence of complications was 30.0%(12/40) in the control group and 11.9%(5/42) in the ERAS group, and the numbers of patients with nausea and vomiting, respiratory complications and cardiovascular complications were 4, 3, 5 cases in the control group and 3, 1, 1 case in the ERAS group, respectively, showing statistically differences in the incidence of complications(χ²=4.08, P<0.05). All the 82 patients were followed up for 2 to 22 months (median time, 12 months), no patients received reoperation or re-admitted to the hospital duo to complications. Conclusion ERAS management in the perioperative period of ACS for BCS is beneficial to postoperative recovery of patients, and can relieve postoperative stress state and inflammatory response, reduce the duration of hospital stay, and incidence of postoperative complications.

Objective To investigate the predictive value of Lp-PLA2 on the successful rate of thrombolysis in patients with a-cute myocardial infarction (AMI) .Methods Patients with AMI within 6 hours of onset were enrolled and blood samples before thrombolysis were drawn for laboratory examination .Alteplase was used for thrombolysis and 2 hours later ,successful rate and the predictive value of baseline Lp-PLA2 level on successful rate were evaluated .Results Totally 106 patients with AMI were enrolled and 48 cases were with anterior AMI ,32 cases with inferior AMI ,12 cases with lateral AMI ,and 14 cases with right ventricular and posterior AMI .Serum levels of cardiac biomarkers ,hs-CRP and Lp-PLA2 were all increased .Two hours later ,38 cases (35 .8% ) were with successful thrombolysis and 68 cases(64 .2% )were with failure ,and there were significant differences of baseline levels of hs-CRP and Lp-PLA2(P<0 .05) .hs-CRP was not correlated with successful rate of thrombolysis (r= -0 .17 ,P=0 .084) ,while Lp-PLA2 was negatively correlated with successful rate of thrombolysis(r= -0 .36 ,P=0 .013)as indicated by the Spearman rank correlation analysis .Conclusion Serum level of Lp-PLA2 can be used to predict the successful rate of thrombolysis in patients with AMI .

Objective To investigate effect of Wenjingtongluo prescription combined with acupuncture and moxibustion on ESR, Fib and hemorheology in patients with cervical spondylosis.Methods 110 cases of cervical spondylosis were divided into two groups, 55 cases in each group.The control group was treated with acupuncture and moxibustion.Experimental group on the basis of acupuncture treatment, were given Wenjingtongluo prescription.The PRI index, VAS score and blood rheology of the two groups were compared.Results The total effective rate of the experimental group was significantly higher than that of the control group (92.73% vs 76.36%) .There was a significant difference (χ2 =5.636, P <0.05) .After treatment, the two groups of PRI index ( emotional score, sensory score, total score ) , VAS score were significantly reduced ( P <0.05 ) .After treatment, the PRI index ( sensory score, total score) and VAS score of the experimental group were significantly lower than those of the control group after treatment.The difference was statistically significant(P<0.05).After treatment, two groups of ESR, Fib, PCV, whole blood viscosity, whole blood viscosity decreased significantly( P<0.05).The experimental group after treatment, ESR, Fib, PCV, whole blood viscosity, whole blood viscosity was significantly lower than the control group after treatment.The difference was statistically significant(P<0.05).Conclusion Wenjingtongluo prescription combined with acupuncture can significantly improve the clinical symptoms, reduce the pain of patients and improve the level of blood rheology.

Objective To explore the efficacy of Chen's cholangiojejunostojmy for tumors around biliary-intestinal anastomosis.Methods The clinical data on 11 patients operated from Jan 2012 to Dec 2014 were retrospectively analyzed.Results All these 11 patients underwent Chen's cholangiojejunostomy.The postoperative liver function significantly improved,and the symptoms of jaundice completely disappeared after operation [ALT (182.0 ±110.6) U/L vs (68.3±33.3) U/L,TBil (316.9 ±153.9) μmol/L vs (60.3 ± 25.8) μmol/L,DBil (184.1 ± 89.6) μmol/L vs (28.6 ± 12.4) μmol/L,P ＜ 0.01;AST (195.5 ± 206.9) U/L vs (48.6 ± 21.2) U/L,GT (806.7 ± 480.0) U/L vs (204.0 ± 99.1) U/L,ALP (612.8 ±424.6) U/L vs (277.5 ± 68.7) U/L,P ＜ 0.05].The level of CA19-9 also significantly decreased [(1 369.75 ± 1 812.18) kU/L vs (71.0 ± 46.5) kU/L,P ＜ 0.05].There were no significant differences in the CA125,CA15-3,CEA levels [CA125 (35.3 ± 26.0) kU/L vs (29.4 ± 23.5) kU/L,CA15-3 (19.4±12.3) kU/L vs (17.9±10.7) kU/L,CEA (8.4 ±7.7) μg/L vs (7.8 ±6.6) μg/L,P ＞ 0.05].There was no perioperative death.All the patients had a smooth perioperative recovery,except in 1 patient who developed bile leakage and another patient who had episodic attacks of cholangitis.There were no recurrent or metastatic tumors detected on follow-up.Conclusion Chen's cholangiojejunostomy was effective in the treatment of bile duct obstruction caused by tumors around biliary-intestinal anastomosis.

Objective To analyze the serum calcium , phosphate and alkaline phosphatase level among apparently healthy school children and adolescents in Heilongjiang Province and establish the reference intervals in different gender and different age groups .Methods Random sample of 2 101 primary and secondary school students from 9 to 18-year-old was collected from different district of Heilongjiang Province including Harbin and Mudanjiang from July 2008 to June 2009 .The fasting venous blood was collected and serum calcium , phosphate and alkaline phos-phatase concentration was measured as soon as possible .After screening outlier individual , a total of 2 091 subjects were enrolled.The reference intervals of serum calcium , phosphate and alkaline phosphatase for healthy school children and adolescents were established by gender and age ( P2.5 to P97.5 ) .Results The change tendency of serum calcium, phosphate and alkaline phosphatase with age and sex were presented .All these parameters had shown inverse relationship with age and were significantly higher in boys than girls (P<0.001).Serum calcium, phosphate of both sexes and serum alkaline phosphatase of girls declined progressively with age .However , the highest alkaline phosphatase level was seen at 13 years in boys.Alkaline phosphatase showed a positive correlation with age before 13 years of age , but after that alkaline phosphatase started to decline .Conclusions Reference in-tervals of serum calcium , phosphate and alkaline phosphatase for healthy school children and adolescents in Hei -longjiang Province in the age group of 9-18 years were presented , which supply good reference value for clinicians especially pediatricians to interpret the results of school children and adolescents and make decision .

OBJECTIVETo analyze the clinical and molecular characteristics of patients with X-linked thrombocytopenia (XLT) and their responsiveness to treatment with various doses of corticosteroids or intravenous immunoglobulin (IVIG) separately.

METHODData from 15 XLT patients who were hospitalized in Children's Hospital Affiliated to Chongqing Medical University from March 2010 to July 2014 were analyzed retrospectively, including clinical manifestations, scores, peripheral blood, immunological functions, responses to IVIG and steroid treatment with various doses and duration.

RESULTAll 15 XLT patients met the inclusion criteria and showed microthrombocytopenia with or without mild-to-moderate eczema or minor infections. Platelet counts ranged from (8-80) × 10⁹/L. The platelet volume value ranged between 5.6 and 10.9 fl (normal range: 9.4-12.5 fl). Raised serum IgG was found in 5 cases, while low serum IgG was found in 2 cases. WAS gene analysis revealed missense mutations in 14 patients, including 4 hotspots (V75M, R86C, R86H, R86L) and 1 novel mutation (Y107C). Flow cytometer analysis of 13 patients showed various amounts of WAS protein (WASP) expression, 2 patients had normal amounts of WASP expression, 5 had reduced amounts, and 6 had absent WASP expression. Their responses to individual steroid and IVIG treatment with various doses and duration were also reviewed. Fourteen patients who were misdiagnosed as immune thrombocytopenic purpura at first received 28 courses of steroids and (or) 47 courses of IVIG treatment. The post-treatment platelet counts of 1 000-2 000 mg/(kg × d) IVIG(25 courses) at 2-7 d and 8-14 d time points were (60 ± 10) × 10⁹/L and (41 ± 7) × 10⁹/L, which indicate a significantly better responsiveness than those by [(31 ± 7) × 10⁹/L, (21 ± 2) × 10⁹/L] of 400-500 mg/(kg·d) IVIG(22 courses) (Z = -4.419, -1.592;P = 0.002,0.011). However, there were no significant differences between the responsiveness of 3 doses [1-2 mg/(kg·d)(8 courses), 3-6 mg/(kg·d) (11 courses) and 20-30 mg/(kg × d)(9 courses)] of steroids (F = 0.387,0.252;P = 0.980,0.761) at 2-7 d and 8-14 d time points. The platelet counts gradually decreased to the primary level at 15-30 d after any doses of steroids and (or) IVIG treatment. The effective rate of 1 000-2 000 mg/(kg × d) IVIG treatment was 18/25, which was significantly higher than that (2/22) of 400-500 mg/(kg × d) (χ² = 9.836, P = 0.008). The effective rate of 20-30 mg/(kg × d) steroids treatment (7/9) was relatively higher than 1-2 mg/(kg × d) (4/8) and 3-6 mg/(kg × d) (6/11) with no significant difference (χ⁹ = 3.235, P = 0.581). After the treatment with steroids and /or IVIG 14 cases with hemorrhage were all improved.

CONCLUSIONThe clinical characteristics of X-linked thrombocytopenia were microthrombocytopenia with or without mild-to-moderate eczema or minor infections. WAS gene and WASP analysis were diagnostic methods. There were no significant differences between the responsiveness of 3 doses of steroids; 1 000-2 000 mg/(kg·d) IVIG had a significantly better responsiveness. However, IVIG and steroids with any dose and duration may only transiently increase peripheral platelet level of XLT patients.

Adrenal Cortex Hormones ; administration & dosage ; Child ; Genetic Diseases, X-Linked ; drug therapy ; Humans ; Immunoglobulins, Intravenous ; administration & dosage ; Platelet Count ; statistics & numerical data ; Retrospective Studies ; Thrombocytopenia ; drug therapy ; Treatment Outcome

Objective To evaluate nutritional status during hospitalization of very low birth weight infant (VLBWI) and to analyze the risk factors for extrauterine growth retardation (EUGR) at discharge.Methods VLBWIs in neonatal intensive care unit (NICU),＜12 hours after birth on admission and length of hospital stay over 14 days from January 10,2007 to October 1,2011,were retrospectively studied.Relevant information,including perinatal data,weekly nutrition supplements and weight gain,and neonatal complications were collected.Data were analyzed by Chi-square test,t-test and multivariate Logistic regression analysis.Results In all 256 VLBWIs recruited,61 (23.8％) were small for gestational age at birth.One hundred and seventy-two cases,who were EUGR by weight at discharge,were divided into EUGR group.While the other 84cases were divided into non-EUGR group.The mean gestational age and mean birth weight of EUGR infants were (29.3± 1.2) weeks and (1 240± 170) g,among them,53.5％ (92/172) were extreme EUGR.Univariate analysis showed that the total energy intake [(84.9±20.9) kcal/(kg · d)],protein intake [(2.6±0.5) g/(kg · d)] and proportion ofenteral nutrition [(26.1 ± 15.3) ％] on day 7 of EUGR infants were lower than those ofnon-EUGR ones [(92.4±20.2) kcal/(kg · d),(2.8±0.5) g/(kg · d) and (30.2± 13.2) ％,respectively,t=-2.71,P=0.007; t=-2.19,P=0.030; t=-2.10,P=0.037].The enteral nutrition at the time to regain birth weight in EUGR group was lower than those in non-EUGR group [(36.4±21.6) kcal/(kg · d)vs (44.2±24.1) kcal/(kg · d),t=-2.58,P=0.011],the average growth rate after regaining birth weight and enteral nutrition proportion on day 14 were lower [(15.5±4.1) g/(kg · d) vs (17.3±3.3) g/(kg · d),(44.6± 16.6) ％ vs (49.5± 14.4) ％,respectively; t=-3.61,P=0.000; t=-2.42,P=0.016].The duration of parenteral nutrition in EUGR infants was longer than that in the non-EUGR infants [(39.6± 13.8) d vs (34.1 ±8.6) d,t=3.94,P=0.000].Multivariable logistic regression showed that small for gestational age at birth,low protein intake and low enteral nutrition proportion on day 7,low rate of weight gain after regaining birth weight were associated with EUGR on discharge,and small for gestational age at birth was the leading risk factor (OR=42.66,95％CI:9.09-200.23).Conclusions The incidence of EUGR among VLBWIs is high on discharge.Enhancing perinatal health care and early rational nutrition support are critical to reduce the incidence of EUGR and improve the neuro-developmental prognosis of these babies.

Objective To investigate the short-term clinical outcomes and perinatal risk factors in very low birth weight infants (VLBWI) with delayed enteral feeding (DEF).Methods Three hundred and fifty-five cases of VLBWI admitted to neonatal intensive care unit from Jan 2007 to Oct 2011 served as study objects,and the clinical data of which were analysed retrospectively.According to days to initiate enteral feeding after birth,355 VLBWI were divided into two groups:DEF group (initiate enteral feeds ≥5 days,n =55)and early feeding group (initiate enteral feeds ≤4 days,n =298).The short-term clinical outcomes were compared in 299 cases,including DEF group 44 cases and early feeding group 255 cases,in which cure or improvement were achieved and hospital stay ＞ 14 d.The perinatal risk factors were subjected to univariate and multivariate logistic regression analysis.Results The incidence of DEF was 16.05％ (57/355) in VLBWI.The time to regain birth weight in DEF group was significantly longer than early feeding group [(11.86 ± 3.86) d vs (9.76 ± 3.83) d,P ＜ 0.01],and the incidences of parenteral nutrition associated cholestasis [27.27％ (12/44)] and extrauterine growth retardation at discharge [79.55 ％ (35/44)] in DEF group were also significantly higher than early feeding group respectively [11.76％ (30/255) and 61.57％ (157/255),P ＜ 0.05].Multivariable logistic regression analysis showed that infants born to mother with placental abruption had higher risk of exposure for DEF than those without placental abruption (OR =2.74,95％ CI 1.06 ～7.05,P ＜ 0.05).Similarly,infants with mechanical ventilation had also higher odds of DEF than those with-out mechanical ventilation (OR =3.51,95 ％ CI 1.92 ～ 6.42,P ＜ 0.01).Conclusion Placental abruption and mechanical ventilation are independent risk factors for DEF in VLBWI.Improving neonatal outcome through enhancing obstetric quality and strengthening cooperation between obstetric and neonatology department is still the key to reduce DEF in VLBWI.