Objective To establish a novel clinical application process of the optical surface monitoring system(OSMS)guided volumetric modulated arc therapy(VMAT)for total body irradiation(TBI),and to assess the accuracy and effectiveness of OSMS in inter-fractional auxiliary positioning before radiotherapy and real-time monitoring of intra-fractional motion during radiotherapy.Methods A retrospective analysis was conducted on 15 leukemia patients who underwent OSMS-guided VMAT-TBI before hematopoietic stem cell transplantation.CT simulation positioning was performed,and the whole-body image data which were collected in head-first supine position(HFS)and feet-first supine position(FFS)were transmitted to the treatment planning system for image registration,multicenter VMAT planning and dose verification.The prescription dose was 800 cGy in 4 fractions twice daily.OSMS was used to assist positioning before delivery,and CBCT was used for position verification.During treatment,OSMS was used for monitoring.The intra-fractional error monitored by OSMS in real time was obtained by analyzing the offline log files.Results The mean dose and coverage of the target area in HFS plan were(905.4±19.0)cGy and 93.0%±2.8%.The mean doses to lung and kidney were(603.7±55.7)cGy and(600.4±49.6)cGy,respectively,and the maximum dose to the lens was(393.9±58.9)cGy.The mean dose and coverage of the target area in FFS plan were(888.5±58.9)cGy and 94.0%±3.2%;and the maximum dose at the junction was(1148.9±72.9)cGy.Fractional treatment delivery time was(75.1±15.1)min.OSMS-assisted positioning was carried out before delivery,and the total deviations of CBCT three-dimensional vector in translational and rotation directions were(2.71±1.96)mm and 0.91°±0.90°,respectively.The three-dimensional vector deviation of the intra-fractional motion amplitude in translational direction monitored by OSMS during the treatment was(1.95±1.88)mm,of which the deviation within 1 mm accounted for 57.5%,79.7%and 62.1%in longitudinal,lateral and vertical directions,respectively.The three-dimensional vector deviation in rotation direction was 0.76°±0.72°,of which the deviation within 1°accounted for 93.1%,85.7%and 94.3%in rotation,pitch and roll directions,respectively.Conclusion VMAT simplifies TBI process,while improving target coverage and organs-at-risk sparing.The use of OSMS can reduce positioning errors,especially rotation errors.In order to ensure the accurate implementation of TBI and the safety of patients,it is necessary to use OSMS for auxiliary positioning and intra-fractional position monitoring.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

Objective:To study the impact of the Varian real-time position management (RPM) respiratory gating system on radiotherapy planning dosimetry.Methods:The radiotherapy plans of 40 cases with thoracic or abdominal tumors were retrospectively selected in this study. The motion phantom for quality control was adopted to generate respiratory gating signals, and the 30%-60% stable phase at the end of expiratory was selected as the respiratory gating window. The dose verification for the abovementioned radiotherapy plans was performed using the Portal Dosimetry (PD) system under RPM respiratory gating mode with the Edge accelerator. Afterwards, dose analysis was performed with different γ passing rate criteria and the distribution characteristics of γ values were analyzed. Finally, the verification results between the non-gating mode and the gating mode were compared.Results:Under the respiratory gating mode, the passing rates of all intensity-modulated radiation therapy/volumetric-modulated arc therapy (IMRT/VMAT) plans with or without flattening filters were over 95.5% by γ criteria of (3%, 3 mm) or (3%, 2 mm) and were over 90% by stricter γ criteria of (2%, 2 mm). All plans met the clinical requirements recommended by the American Association of Physicists in Medicine (AAPM). The passing rates of dose verification under non-gating mode were slightly better than those under respiratory gating mode, and the differences between the two modes were statistically significant (3%/3 mm, Z =-1.45; 3%/2 mm, Z =-2.86; 2%/2 mm, Z =-3.70; 1%/1 mm, Z =-4.52; P<0.05). There was no significant difference in the minimum and maximum values of γ and the share of γ > 1.5 of plan verification result under the two modes. However, the average value and standard deviation of the γ were generally smaller under the non-gating mode. Conclusions:The impact of the introduction of RPM respiratory gating technology on dose is clinically acceptable, and the execution of these plans in this gating mode is safe and reliable.

Objective: To investigate the influencing factors of colorectal cancer and precancerous lesions among cured leprosy patients, so as to provide insights into prevention of colorectal cancer among cured leprosy patients. Methods: All cured leprosy patients were recruited from each leprosy village (hospital) in Zhejiang Province from 2019 to 2020. Participants' demographic features, family and medical history of intestinal polyps, smoking, alcohol consumption, dietary behaviors and defecation during the recent three years were collected using questionnaire surveys. Colorectal cancer and precancerous lesions were diagnosed using rectal examination, electronic colonoscopy and histopathological examinations, and factors affecting the development of colorectal cancer and precancerous lesions were identified with a multivariable logistic regression model among cured leprosy patients. Results: Totally 100 cured leprosy cases were enrolled, including 72 men and 28 women, and with a mean age of (67.23±3.42) years. There were 13 cases with grade 0 leprosy disability, 16 cases with grade 1 leprosy disability and 71 cases with grade 2 leprosy disability. The detection of colorectal cancer and precancerous lesions was 5.00% and 26.00%, respectively. Multivariable logistic regression analysis showed that age of 65 years and older (OR=7.128, 95%CI: 5.019-10.123), disability (OR=4.591, 95%CI: 2.942-7.163), a medical history of intestinal polyps (OR=4.031, 95%CI: 3.052-5.325), eating moldy food frequently (OR=4.433, 95%CI: 2.920-6.729), seldom eating vegetables (OR=4.411, 95%CI: 3.204-6.071), bloody stools (OR=4.341, 95%CI: 2.771-6.799), mucous stools (OR=4.577, 95%CI: 2.771-7.559) and presence of depression (OR=3.935, 95%CI: 3.026-5.117) were statistically associated with the development of colorectal cancer and precancerous lesions among cured leprosy patients. Conclusion Advanced age, disability, history of intestinal polyps, frequent intake of moldy food, infrequent consumption of vegetables, bloody stools, mucous stools, and depression may increase the risk of colorectal cancer and precancerous lesions among cured leprosy patients.

Objective To establish a method that could detect 5 components of Fufang Heishen oral liquid simultaneously. Methods The component was performed by high performance liquid chromatography ( HPLC) equipped with Agilent Hypersil ODS (4.6 mm×250 mm,5 μm).The mobile phase consisted of acetonitrile-0.1% Phosphoric acid with gradient elution.The flow rate was 1.0 mL·min-1with the 210 nm and 270 nm detection wavelength,20 μL injection volume and 30 ℃column temperature. Results A good linear relationship was observed with the range of 7.12-85.44 mg·L-1for Harpagide (r＝0.999 9),2.50-30.00 mg·L-1for Harpagoside(r＝0.999 8),25.35-304.20 mg·L-1for Cinnamic acid(r＝0.999 7),0.73-8.70 mg·L-1for Tectoridin(r＝0.999 7)and 1.20-14.40 mg·L-1for Irisflorentin(r＝0.999 8).The average recovery of each detected component of Fufang Heishen Oral Liquid was 98.8%,102.7%,98.8%,99.3%,99.9% the RSD were 1.23%,2.89%, 2.60%,1.44%,2.84%(n＝6). Conclusion The method is simple,rapid and accurate and can be used to detect the content of Harpagide,Harpagoside,Cinnamic acid,Tectoridin and Irisflorentin of Fufang Heishen Oral Liquid.

Objective To observe the change of coagulation function in chronic stress depression model rats and the effects of elec-troacupuncture (EA) on it. Methods A total of 32 Sprague-Dawley rats were randomly divided in control group (n=8), model group (n=8), EA group (n=8) and fluoxetine group (n=8) after a week of acclimation. The 21-day unpredictable mild stress combined with solitarily feed-ing was used to make the depression model in the latter three groups, meanwhile EA group and the fluoxetine group accepted EA and fluox-etine. They were measured the prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (FIB). Serum levels of 6-keto-prostaglandin F1α(6-keto-PGF1α), P-selectin, thromboxane B2 (TXB2) were determined with enzyme-linked im-munoabsorbent assay. Results The cross and rear scores were significantly lower in the model group than in the control group (P<0.01). The scores increased in EA group and the fluoxetine group (P<0.01) compared with the model group. Compared with the control group, PT, APTT and TT decreased (P<0.01), FIB increased (P<0.05), the level of 6-keto-PGF1αdecreased, the level of P-selectin and TXB2 increased (P<0.01) in the model group. Compared with the model group, PT, APTT and TT increased (P<0.05), the level of 6-keto-PGF1αincreased (P<0.01), and the level of P-selectin and TXB2 decreased (P<0.05) in EA group and the fluoxetine group, and FIB decreased in EA group (P<0.05). Conclusion The chronic stress depression rats are impaired in the coagulation function and platelet activation, and can be allayed with electroacupuncture and fluoxetine.

Objective:To optimize and improve the content determination method for nitroglycerin ointment. Methods:An HPLC method was used,the column was Hypersil ODS(150 mm × 4. 6 mm,5 μm),the mobile phase was acetonitrile ∶water(50 ∶50),the detection wavelength was set at 220 nm,the flow rate was 1 ml·min-1 ,the column temperature was 30℃,and the injection volume was 20 μl. Results: The results showed a good linear relationship within the concentration range of 0. 020 3-0. 203 3 mg · ml-1 ( r =0. 999 9),and the average recovery was 99. 51%(RSD=1. 06%,n=9). Conclusion: The method is rapid,accurate and reproduci-ble,and can be used to determine the content of nitroglycerin in nitroglycerin ointment.

Objective To investigate the potential tigecycline resistance of Klebsiella pneumoniae during treatment.Methods The minimum inhibitory concentrations (MICs) and the mutant prevention concentrations (MPCs) of tigecycline were determined for K.pneumoniae isolates with four different resistant profiles.Corr.elations between MICs and MPCs were analyzed.We combined with the pharmacokinetic parameters of tigecycline to estimate the potential of emerging resistance to tigecycline monotherapy in K.pneumoniae.Results The MPCs of tigecycline for the carbapenem-and fluoroquinolone-resistant isolates were found to be 8-fold higher than those for carbapenem-and quinolones-susceptible isolates.Our data showed that the MPCs range and MPC90 values of tigecycline were 4-512 mg/L and 64 mg/L,respectively,which were much higher than the therapeutic concentrations of tigecycline in serum and tissues.Conclusions Long-term tigecycline monotherapy may predispose the emergence of resistance in K.pneumoniae,which is not recommended.It is desirable to carry out ongoing monitoring of K.pneumoniae susceptibility and tigecycline treatment effect.

Objective:To analyze pharmaceutical procurement model of hospital, and explore better pharmaceutical procurement model so as to suit the development of modern hospital.Methods: Combined with the current situation of pharmaceutical procurement in domestic medical organization in recent years to analyze the current problems that existed in pharmaceutical procurement of hospital management.Results: Aimed at the problems that existed in procurement management model in current hospital, the reasonable suggestions have been proposed, and these suggestions have provided reference and experience forpharmaceutical management and procurement in hospital.Conclusion: Pharmaceutical procurement is the material basis of pharmaceutical supply of pharmaceutical trading enterprise, and it is the start point of pharmaceutical circulation and distribution, and it also is the first important step. Especially, aimed at the institutional reform of separating pharmacy from clinic in Beijing, the normalization of pharmaceutical procurement management will be very important effect in working practice.