This experiment confirmed that the cause of rupture of the anastomosis in gastroenterostomy did not depend upon the layers of suture The rupture of anastomosis did not occur between the needle suture points if the submucosa was properly sutured, it may occur when the needle suture hole was gradually enlarged and connected each other So, it is reasonable that the distance of suture points should be kept about 0 5cm If the distance is too short or the suture layers are too many, it is not good for the healing of the anastomosis

Objective Knowledge?based radiotherapy ( KBRT ) can reduce the plan quality variability induced by different experiences between physicians and improve the quality of treatment plans. Methods The Varian Rapid Plan system was used to train a dose?volume histogram ( DVH) prediction model. The obtained model was preliminarily applied to semi?automatic design of the preoperative treatment plans for rectal cancer. Eighty high?quality volumetric modulated arc therapy plans were imported into the model training set of the Rapid Plan system. The structures of the plans were matched to the corresponding labels and codes as listed in the library. The training started after the verification of prescription. The residual plots,regression curves,geometric plots for organ at risk ( OAR) ,in?field DVH plots,and model training logs were examined. After removal of the mismatch, the original plans were assessed to rule out outliers and influential data points. More similar plans may be added for another round of training. Ten KBRT plans were designed using the final model and compared with the clinical plans. Results For the two major OARs,the femoral head and bladder,the average goodness of fit of the principal component were 0?999 415/1.0 and 0?999 963/1.0 for the DVH model,and 0?999 651/1.0 and 0?999 945/1.0 for geometry?based expected dose model,respectively. In all the plans, 11 had Cook ’ s distance values exceeding the tolerance and 4 had studentized residual values exceeding the tolerance. The outliers were all kept in the training set to generalize the scope of the model. The 10 KBRT plans had significantly improved homogeneity indices for PGTV and PTV than the original plans (P=0?00,0?04).The 10 KBRT plans also had significantly reduced D50% to the femoral head and bladder as well as significantly reduced mean doses to the bladder than the original plans (P=0?042,0?000,0?005). Conclusions In this study,the Rapid Plan system is used to train a KBRT model for design of preoperative radiotherapy plans for rectal cancer. The results of preliminary application meet the clinical requirements.

Objective:To explore influence of negative emotions on prognosis of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI) .Methods :Self‐rating anxiety scale (SAS) and self‐rating depression scale (SDS) were used to assess 90 patients undergoing PCI .According to the score results ,patients were divided into pure depression group (n=28 ,occupied 31.11% ) ,pure anxiety group (n=22 ,24.44% ) ,anxiety com‐plicated depression group (n= 25 ,27.78% ) and normal group (n = 15 ) . All patients were followed up for 12 months ,and Logistic regression analysis was used to analyze risk factors for major adverse cardiovascular events (MACE) .Results:Incidence rates of MACE in pure depression group ,pure anxiety group and anxiety complicated depression group were significantly higher than that of normal group (42.86% vs .40.91% vs .64.00% vs .6.67% , P<0.05 or <0.01) ,and that of anxiety complicated depression group was significantly higher than those of pure depression group and pure anxiety group (P<0.05 both) .Logistic regression analysis indicated that anxiety ,depres‐sion ,anxiety complicated depression were risk factors for MACE (OR = 1.49 ,2.16 ,3.28 , P < 0.05 or < 0.01) . Conclusion : Most patients undergoing coronary intervention possesses negative emotions ,which are risk factors for adverse clinical events and affect their prognosis .

Objective To explore the Monte Carlo calculation methods for the absolute dose calibration and output factor of 6 MV flattening-filter ( FF) and flattening-filter free ( FFF) photon beams based on TrueBeam accelerator .Methods The BEAMnrc code was used to model the LINAC head of FF and FFF modes.The BEAM_up covers the components from the target to the monitor chamber , and BEAM_down includes the structures beneath the chamber , the dose deposit to the monitor chamber contributed by the incidence electrons and scattered particles from the secondary collimators were calculated respectively .The incidence electron-induced dose at certain depths on the central axis were simulated by means of the DOSXYZnrc code .By means of dose calibration equation , the calibration factor for the standard field (10 cm ×10 cm) and the output factors for various fields (1 cm ×1 cm-40 cm ×40 cm) were computed respectively .Results For the 6 MV FF and FFF beams under the standard 10 cm ×10 cm field, 1 MU equals to 7.747 ×1013 ±3.099 ×1011 and 3.248 ×1013 ±1.624 ×1011 electrons to the target , respectively , which deposited 21.53 and 35.01 cGy to the monitor chamber of the virtual accelerator respectively .The difference between the simulated and calculated output factors were 0.72%±1.4%and 0.56%±0.78%for FF and FFF , respectively .Conclusions The model generated and measured output factors agree well , indicating the good accuracy of the dose calculation by the model , which would provides basis for further clinical dosimetric studies .

Objective:To explore influence of different guide wire on transradial coronary angiography (CAG). Methods:A total of 238 patients,who received successful transradial CAG in our hospital from Nov 2009 to Jan 2013,were selected.According to kinds of guide wire,they were divided into group A (n=119,used ordinary J type exchange guide wire)and group B (n=119,used loach exchange guide wire.Trafficability,supporting force and incidence rate of complications were compared between above two groups.Results:The trafficability of loach exchange guide wire was significantly better than that of ordinary J type exchange guide wire,the pass rates of elbow joint (98.3% vs.87.4%)and brachiocephalic trunk (100% vs.96.2%)were significantly higher than those of or-dinary J type exchange guide wire (P<0.01 or <0.05).For guide wire support to rotate catheter,ordinary J type exchange guide wire had obvious advantages,its success rate of left CAG (98.3%)was significantly higher than that of loach exchange guide wire (89.1%),P<0.01.There were no significant differences in incidence rate of compli-cations between two groups.Conclusion:Ordinary J type exchange guide wire could be preferred in coronary angiog-raphy,and loach exchange guide wire can be considered if the former can't pass.

Objective To evaluate the feasibility and dosimetric features of a volume modulated arc therapy (VMAT)-configured model in knowledge-based optimization of fixed-field dynamic intensitymodulated radiotherapy (IMRT) plans based on the Varian RapidPlan system.Methods ① A dose-volume histogram prediction model was trained with 81 qualified preoperative VMAT plans for rectal cancer and then statistically verified.② For clinically approved 10 IMRT plans with the same dose prescription,the above model was used to automatically generate new optimization parameters and dynamic muhileaf collimator (MLC) sequences with field geometry and beam energy unchanged.③ In order to rule out the disparities between different versions,a single algorithm was used to calculate the absolute doses of the original and new plans.④ Statistical analyses were performed on dosimetric parameters after comparable target dose coverage was achieved in the two plans by appropriate normalization.Results On the basis of similar target dose homogeneity and coverage,RapidPlan significantly reduced the doses to the urinary bladder (D50％ by 9.01 Gy,P =0.000;Dmean by 8.08 Gy,P =0.005) and the femoral head (D50％ by 4.20 Gy,P =0.000;Dmean by 3.84 Gy,P=0.005) but significantly elevated the mean total number of monitor units (1211±99 vs.771±79,P=0.000) and the number of fields with multiple MLC carriage groups.The knowledge-based semi-automated optimization caused a significantly larger number of high-dose hotspots but a similar D2％ (52.54 vs.52.71 Gy,P=0.239).Conclusions The VMAT model can be used for the knowledge-based semi-automated optimization of IMRT plans to enhance the efficiency and OAR protection.However,the resulting high-dose hotspots need further manual intervention.

Objective To assess the relationship between fruit intake and gastric cancer.Methods Articles published during January 2001 and October 2012 that assessed the relationship between fruit intake and gastric cancer were searched on PubMed,Ovid and Willey database.Adjusted relative risk (RR) and 95％ confidence intervals (CI) were calculated by using fixed-effect or random-effect model.Variants of subgroup analysis included living regions,followup duration,and adjusted factors.Results A total of 3679 gastric cancer patients and 1 173 859 subjects from 7 prospective cohorts were included in this metaanalysis,and the pooled RR was 0.89 (95％ CI:0.78-1.01).In the subgroup analysis,the pooled RR in the 10-year followup group was 0.94 (95％ CI:0.85-0.99) before age,cigarette smoking and alcohol drinking were adjusted (RR =0.81,95％ CI:0.54-0.99).Conclusion Fruit intake may prevent the development of gastric cancer.

Objective To compare the treatment effect between Duply combined with Duckett and Koyanagi surgical methods in severe hypospadias.Methods Forty-two cases of severe hypospadias were divided into two groups according to the surgical method,23 cases was enrolled in Duply combined with Duckett group while 19 cases in Koyanagi group.The operation time,the incidence rate of urinary fistula,urethral stricture,urethral diverticulum and penis torsion were compared.Results The operation time between two groups had no significant difference (P ＞ 0.05).The incidence rate of urinary fistula,urethral stricture,urethral diverticulum and penis torsion between two groups had no significant difference (x2 =0.04,0.31,0.03,1.16,P ＞ 0.05).The total incidence rate of complications between Duply combined with Duckett group and Koyanagi group had significant difference [69.6％ (16/23) vs.6/19] (x2 =4.59,P ＜ 0.05).Conclusion Each of the two methods can be a choice in treatment of severe hypospadias.

Objective:To investigate the performance of W2 plastic scintillator in megavolt photon and electron beams.Methods:The photon and electron beam energy provided by linear accelerator was used to collect data of the W2 scintillator. The parameters include the electrometer reading stability, W2 dose and dose rate linearity, and angular response. And the dose uncertainty of the W2 correction factors was also investigated.Results:The standard deviation of the electrometer reading stability was between 0.03 and 0.47. The linear regression factors of W2 dose were all 1.0; the maximum deviation of the dose rates was 0.61%. The Cerenkov light radiation correction factor(CLR) for 6 and 10 MV were 0.741 and 0.746, respectively, and the CLR for 6, 9, 12 and 15 MeV were 0.750, 0.753, 0.757 and 0.757, respectively. The maximum deviation of dose uncertainty for 15 MeV was 3.15%.Conclusions:The signal obtained by the blue and green channel was no angular dependence, the same as the high-energy electron beam, which verified that the Cerenkov radiation correction factor has good linearity. W2 plastic scintillator can be applied to non-coplanar radiotherapy dosimetry.

Objective To investigate the nutritional risk,undemutrition,and nutrition support in inpatients with early and middle stage gastrointestinal cancer undergoing radical surgery in a tertiary hospital in Weifang,Shandong Province.Methods A total of 8390 inpatients who were treated in the departments of oncological surgery,enterohepatic surgery,and general surgery in our hospital were consecutively recorded from December 2010 to August 2011 and from November 2011 to October 2012.After 153 patients were excluded for hospital length of stay less than 24 hours,age less than 18 years old or more than 90 years old,obnubilation,and/or refusal to participate in the research,8237 patients were sampled.After patients who did not meet the scheduled diagnosis were excluded,300 pathology-confirmed patients with early or middle stage gastrointestinal cancer were enrolled.Nutritional Risk Screening 2002 (NRS 2002) was performed within the first 48 hours after admission and nutrition support was evaluated until the discharge.Results A total of 300 early and middle stage gastrointestinal cancer patients (141 cases of gastric cancer and 159 cases of colorectal carcinoma) who underwent radical surgery met the inclusion criteria.Among them 185 (61.7％) were at nutritional risk.The undernutrition rate was 12.3％ (37/300) if evaluated from the score of nutritional defect part of NRS 2002,and 10.0％ (20/300) if based on body mass index ＜18.5 kg/m2.Totally 165 patients (89.2％) at nutritional risk and 99 patients (86.1％) without nutritional risk received nutrition support.The average ratio of parenteral nutrition to enteral nutrition was 82:1.The intake of calories was (78.1±24.8) k1/(kg,d) [(18.6±5.9)kcal/(kg·d)] and that of nitrogen was (0.10±0.06) g/(kg · d),yielding a ratio of calories vs.nitrogen of (244 ± 164)∶1.Conclusions Inpatients with early and middle stage gastrointestinal cancer tend to have high nutritional risk.The undernutrition rate is 10％-12.3％ in this population.Meanwhile,the application of nutrition support should be further standardized,particularly for patients without nutritional risk.