Objective To evaluate efficacy on treatment of acute iliofemoral lower extremity deep venous thrombosis with thrombectomy and pharmacological thrombolysis or pharmacological thrombolysis alone. Methods The clinical data of 175 cases of lower extremity iliofemoral deep venous thrombosis wereanalysed retrospectively. Patients were divided into thrombectomy group and thrombolysis group. There were 85 patients treated by thrombectomy, among these patients there were 46 with common iliac vein occlusion or stenosis. According to state of illness suitable treatment was selected, urokinase and low molecular weight heparin were given after operation. The other 90 patients were treated by pharmacological thrombolysis only,including urokinase and low molecular weight heparin. Results No significant differences were found in age, course of disease, swelling and associated diseases between the two groups before treatment (P ＜0. 05); After 1 month of treatment the circumference difference between bilateral limbs was reduced from (4.6±1.6) cm to (0.8 ±0.5) cm in operation group,and declined from (4.0±1.9) cm to (1.8 ±1.3) cm in thrombolysis group. The cure rate was 71.8% (61/85) in thrombectomy group and 38.9% (35/90) in thrombolysis group. 64.6% patients were followed up for an average of (28 ± 11 ) months.After 12 months of treatment the circumference difference between bilateral limbs was (0.4 ± 0.3 ) cm in thrombectomy group and ( 0.9 ± 0.7 ) cm in thrombolysis group respectively. The cure rate was 86.0% (49/57) in thrombectomy group and 53.6% (30/56) in thrombolysis group. In surgical group the incidence of deep venous thrombosis sequelae was less than in thrombolysis group( P ＜0. 05 ). The incidence of venous valve dysfunction in thrombectomy group was less than in thrombolysis group (P ＜ 0.05 ).Conclusions Thrombectomy and pharmacological thrombolysis was more effective than pharmacological thrombolysis alone in the treatment of acute iliofemoral deep venous thrombosis.

Radiotherapy is an effective way to reduce the local recurrence rate and mortality of breast cancer.However,the risk of long-term side effects of radiation-induced cardiac injury cannot be ignored.Especially for patients undergoing left breast ra-diation therapy,the risk of cardiac injury is higher due to the heart being within the radiation field,which increases the incidence of radiation induced heart disease and ultimately affects long-term survival rate and quality of life.Therefore,it is particularly important to prevent radiation induced cardiac injury.The main measures include using advanced radiation therapy techniques such as intensity modulated radiation therapy,volume modulated arc radiotherapy,deep inhalation and breath holding radiation therapy,prone position radiation therapy,proton beam therapy,etc.or optimizing the radiotherapy plan for cardiac substructure to reduce the radiation dose to key cardiac structures.This article will review the research progress of pathophysiological mechanism,clinical manifestations,risk fac-tors and preventive measures of radiation-induced cardiac injury in breast cancer.

Objective:To evaluate the effect of teacher simulate standardized patient (TSSP) consultation training in pediatric practical teaching.Methods:A total of 120 interns from the five-year clinical medicine major of Batch 2015 were randomly divided into experimental group and control group. In the experimental group, 60 interns were trained by TSSP for consultation after admission. After the training, the clinical parents of the children were consulted and the children were physically examined under the guidance of teachers. In the control group, 60 interns were trained according to the same requirements, but TSSP consultation training was not included. At the end of the practice, the performance, operation skills and medical record writing ability of the interns were compared, and the satisfaction of the experimental group was investigated. SPSS 25.0 software was used for t test and chi-square test. Results:The medical record writing results of the experimental group were (96.15±3.00) points, significantly higher than that of the control group [(81.02±3.29) points], and the differences were statistically significant ( t = 26.38; P < 0.001). In the mini-clinical evaluation exercise (Mini-CEX), the scores of medical history collection, communication skills, humanistic care and physical examination were significantly higher than those of the control group ( t= 15.41, 17.67, 15.39 respectively; all P < 0.001). The experimental group had high satisfaction with the teaching method of TSSP consultation training. Conclusion:TSSP consultation training improves the intern medical record writing ability, doctor-patient communication ability, clinical operation ability, stimulates the learning interest of interns, trains the trainee doctors humanistic consciousness, integrates into the ideological and political education, effectively ensures the quality of practical teaching of pediatrics, and obtains recognition from intern, which is worth promoting.

Objective:To investigate the correlation between radiation dose of the pelvic bone marrow of different anatomical bony sites and the incidence of neutrophil toxicity during the three-dimensional radiotherapy concurrent chemotherapy for cervical cancer.Methods:Clinical data of 117 cervical cancer patients who received three-dimensional radiotherapy concurrent chemotherapy from 2016 to 2018 were retrospectively analyzed. The dosimetric parameters included D mean, V 5Gy, V 10Gy, V 20Gy, V 30Gy, V 40Gy and V 50Gy. The correlation between the dosimetric parameters and the lowest neutrophil count was analyzed by linear regression analysis. Clinicopathological features and dosimetric parameters were included into the multivariate regression analysis model. Results:The incidence rates of neutrophil toxicity (grade 1-4) were 10.3%, 27.4%, 11.1% and 10.3%, respectively. The linear regression analysis showed that the D mean and V 50Gy of lumbosacral vertebrae (LS), the D mean, V 5Gy, V 10Gy, V 20Gy, V 30Gy, V 40Gy and V 50Gy of the ilium were significantly correlated with the grade 2-4 neutrophil toxicity ( P=0.035、<0.001、<0.001、=0.001、=0.003、=0.001、<0.001、<0.001、<0.001). Multivariate analysis demonstrated that the V 20Gy, V 30Gy and V 50Gy of the LS, the D mean, V 5Gy, V 10Gy, V 20Gy and V 30Gy of the ilium were significantly correlated with the grade 2-4 neutrophil toxicity ( P=0.046、0.038、0.049、0.041、0.039、0.029、0.036、0.029). Conclusion:During the process of three-dimensional radiotherapy concurrent chemotherapy for cervical cancer, the volume of medium-and high-dose of LS and the volume of low-and medium-dose of ilium are significantly correlated with the risk of neutrophil toxicity.