Objective To evaluate the role of anti-cyclic citrullinated peptide antibody(ACCP) and rheumatoid factor(RF) in patients with rheumatoid arthritis.Methods ACCP antibody and RF were detected in serum samples of 90 RA patients,30 other diseases patients and 35 healthy blood donors.The sensitivity,specificity,positive predictive value,negative predictive value,agreement rate and Youden`s index of these parsmeters for the diangnosis of RA were analyzed.We maped the receiver operative characteristic curve(ROC) and calculated area under the ROC curve.Results The positive rates of ACCP and RF were higher than those of patients with other diseases or healthy controls(P0.5).Conclusion ACCP is a valuable index for RA diagnosis.It is useful in improving the diagnostic accuracy of RA.

With the internationalization of nursing education,one major project facing higher nursing education is to foster lots of high quality nursing specialists,with properties of international vision,development prospect,and adaptation to international nursing positions.Chongqing Medical University engaged in reforming and implementation of talents culturing and yielded significant effect along with the main competency ideology of humanistic caring,critical thinking,evidence-based nursing,practicing and international competition.

Objective To use clustering analysis to help physicians detect abnormal parameters in radiotherapy treatment plans and improve the efficiency of plan verification. Methods From 2010 to 2015, 835 breast cancer treatment plans for using 4?field hybrid intensity?modulated radiotherapy from MOSAIQ were collectted. Fractional dose, beam angle, and monitor unit were used as featured parameters of a treatment plan to generate a dataset. The K?means clustering algorithm based on principal component analysis was used to perform a clustering analysis of the dataset and divide the dataset into different clusters. The outliers of clusters were automatically detected based on the distance threshold. The outlier?contained treatment plans were manually verified by physicians to determine the accuracy of clustering analysis in detection of abnormal plans. Results In the clustering analysis, the sample space composed by parameters of treatment plans for breast cancer was divided into 4 clusters, 3 of which had outliers detected. In the targeted treatment plans, 3 plans became outliers because of special target volume and the other 4 plans needed improvement. Conclusions Clustering analysis is effective to help physicians to independently verify treatment plans.

Object To study the origin, morphology and histology of Galla Cinnamomi Camphorae(GCC). Methods By the literature investigation and the survey in the production area, GCC was identified by microscopic technique. Results The origin and the medicinal part of GCC were defined. Conclusion GCC is the abnormal fruit of Cinnamomum camphora (L.) Presl which has been infected by Exobasidium sawadae Yamada and formed with hymenium and fruit. The characters in morphology and histology of GCC provide the scientific reference of identification of the crude drug.

Objective To find a model of long-term postoperative cognitive dysfunction by hav-ing a splenectomy operation or cardiopulmonary bypass.Methods Sixty Sprague-Dawley rats,aged 18 months,were randomly divided into 3 groups (n =20):splenectomy group (group A),cardiopul-monary bypass group (group B)and control group (group C).From 31 st to 35 th days after the opera-tion,the learning and memory capability of rats were observed through the Morris water maze,the Shuttle box text and Open field test.Results Compared with group C,the frequency of crossing the original platform [(5.2±2.2)times vs.(8.6±3.2)times],the times of initiative avoiding were sig-nificantly reduced [(12.3±2.7)times vs.(1 5.2±1.8)times],the latency of the initiative avoiding was significantly prolonged [(9.50±2.31 )s vs.(5.14 ± 1.43 )s],the number of standing on the back legs [(6.8±1.5)times vs.(10.2±1.7)times]and rearing were significantly reduced [(13.8± 2.6)times vs.(1 9.5±2.2)times],and the time that animals spent in the central square [(7.78 ± 1.5 1)s vs.(5.34±0.72)s]and escape latency were significantly prolonged in group B (P <0.05). Compared with group A,the time that animals spent in the central square in group B was significantly prolonged [(7.78±1.5 1)s vs.(6.06 ±1.67)s,P <0.05].Conclusion The model by having car-diopulmonary bypass operation is an ideal model of postoperative cognitive dysfunction after cardio-vascular anesthesia,for the learning and memory capability is remarkably changed.

Objective To observe the effects of preoperative acute hypervolemic hemodilution (AHH) on coagulation and fibrinolysis on the elderly patients undergoing hepatic carcinectomy.Methods Thirty ASA Ⅰ～Ⅱ liver cancer patients over sixty years old undergoing scheduled elective hepatic carcinectomy were random divided into AHH group ( n = 15) and control group ( n = 15).AHH was performed by infusing 15 ～20ml/kg 6% Voluven ( 130/0.4) in a rate of 30ml/min on patients in AHH group,and the patients in control group were infused routinely lactated Ringer's solution.Blood samples were collected for measuring coagulation function and platelet activation before anesthesia (T1) ,30 minutes after AHH (T2),1 hour ( T3 ), immediately (T4) and 24 hours (T5) after operation in group AHH, and the similar procure was used in control group.Results There was significant difference in the volume of allergenic blood transfusions between the two groups(20% vs 53.3%, P ＜0.05).PT and APTT in both groups prolonged significantly after T2, but they all remained in normal range.TT and DD had no significant changes between the two groups.SFMC and F1 + 2 increased in both groups, but it had no significant changes.PAC-1 and CD62P expressions of group AHH were significantly lower T2, T3 ,respectively ( 1.37 ±0.4) %, (1.28 ±0.4) %, than those at T1 [( 1.96 ± 0.6) %] ( P ＜ 0.05 ).Compared with control group, CD62P was significantly lower in AHH group at T2 and T5.Conclusion It is safe to take AHH of Hct 25% to 30% during hepatic carcinectomy for elderly liver cancer patients without cardiac and pulmonary disease.And it could decrease allergenic blood transfusions, with no apparently influence on coagulation function.

Objective To evaluate the effects of four types of variance reduction techniques ( ring counter grid, high electron cutoff energy, termination of electron tracking in some structures, and emission direction?biased sampling of source) on the efficiency and accuracy of Monte Carlo simulation for the single source channel of the Leksell Gamma Knife. Methods The single source channel of the Leksell Gamma Knife was modeled using Monte Carlo software MCNP . Four types of variance reduction techniques were used to simulate the dose distribution in the water?like phantom. The computation efficiency and simulation result were compared between the four techniques. Results All techniques substantially improved the computation efficiency and had little effect on the accuracy of the simulation ( relative error less than 2. 5%) . However, if the electron cutoff energy was above 50 keV, the simulation became quite inaccurate due to neglect of the scattering of high?energy electrons and their dosimetric contribution to the penumbra. When the scattering of high?energy electrons and their dosimetric contribution to the penumbra were ignored, the dose to the Profile platform was overestimated and the dose to the penumbra was underestimated. Conclusions Rational use of variance reduction techniques can substantially improve the efficiency of Monte Carlo simulation for the single source channel of the Leksell Gamma Knife. However, the impact of variance reduction techniques on the accuracy of the simulation should be carefully evaluated.

Objective To develop whole breast irradiation with volumetric-modulated arc therapy (VMAT)-based hybrid intensity-modulated radiotherapy (IMRT) after breast conserving surgery for breast cancer,and to evaluate its value in clinical application.Methods Ten patients with breast cancer undergoing breast conserving surgery were enrolled.Two radiotherapy plans were designed based on hybrid fixed-beam IMRT/IMRT technique and hybrid VMAT/IMRT technique,respectively.One group received whole breast irradiation with a prescribed dose of 50 Gy in 25 fractions.The other group received whole breast irradiation with a prescribed dose of 50 Gy in 25 fractions,as well as simultaneous integrated boost to the tumor bed with 60 Gy in 25 fractions.The dosimetric parameters and delivery efficiency were compared between the two plans using paired t test.Results For patients treated with whole breast irradiation alone,there were no significant differences in conformity index and homogeneity index of target volume between the two plans (P=0.866,0.056);however,compared with the hybrid fixed-beam IMRT/IMRT technique,the hybrid VMAT/IMRT technique significantly increased the doses to organs at risk (OARs) and the number of monitor units (MUs) in the intensity-modulated field (P=0.000-0.050,P=0.002).For patients treated with whole breast irradiation with a simultaneous integrated boost to the tumor bed;however,the hybrid VMAT/IMRT technique significantly reduced the doses to the lung and spinal cord,number of MUs in intensity-modulated field,and delivery time compared with the hybrid fixed-beam IMRT/IMRT technique (P=0.004,0.001,0.000,0.000).Conclusions For patients treated with whole breast irradiation with a simultaneous integrated boost to the tumor bed,the hybrid VMAT/IMRT technique is highly promising for clinical application due to better OAR sparing and higher delivery efficiency.

Deep venipuncture catheterization is a routine and basic operation in the treatment of critically ill patients, and it is the most effective way to quickly correct the shock. Clinical B-ultrasound guided deep vein catheters can improve the success rate of puncture, but in the process of operation, the short axis needs to be replaced by the long axis. In the replacement process, the stability of the novice is insufficient, the positioning is difficult, and the operation time is too long. If only short axis puncture is used, it is impossible to know whether the current position of the puncture needle, and the puncture may be too deep and stray into the artery. The accuracy of the 45 degree angle of the injection point requires a very experienced operator. In view of the above shortcomings, doctors in the department of critical care medicine of Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine designed a B-ultrasound puncture equipment, which has obtained the National Invention Patent of China (ZL 2016 1 0571557.X). The device is composed of B-ultrasound probe fixing frame, sliding scale plate, simulation slide rule, puncture needle, sliding device. By sliding device the angle of the pinhole channel, it is conducive to the accurate positioning of the puncture target, optimizing the operation procedure, improving the puncture speed and accuracy, effectively reducing the occurrence of puncture complications, ensuring patient safety, reducing unnecessary waste of human and material resources. It can reduce the workload of medical staff and is worthy of clinical practice.
Humans ; Catheterization, Central Venous/methods* ; Ultrasonography, Interventional/methods* ; Ultrasonography ; Punctures/methods* ; Needles

Objective To analyze the influencing factors of cone-beam CT (CBCT) imagine registration in lung cancer. Methods From Mar. 2007 to Dec. 2007, 20 patients with lung cancer were treated with IGRT. The imagines of CBCT were collected from 6 to 19 fractions during the patients' radiotherapy. To compare the difference of set-up errors between the two groups according to the distance from the lesion in lung to the centrum. At the same time, CBCT imagines from the first, middle and the last fraction of these patients' radiotherapy were registrated in bone and grey methods by four doctors. The difference of set-up errors between different doctors and registrated methods were compared. Results The mean values of set-up errors were ＜2 mm in the two groups without significant difference (x:-1.31mm vs 0. 10 mm (t=0. 07,P=0.554);y:1.24 mm vs 1.37 mm (t=0. 05,P=0. 652);z: - 1.88mm vs -1.26mm (t= -0. 12,P=0.321)). The mean values of set-up errors were ＜ 1.3 mm in four doctors and registrated methods without significant difference, for bone registration,x: -0. 05 mm, -0. 01 mm,0. 05 mm, -0.12 mm and -1.31 mm ( F=-0.01,P=0.887) ;y:0.56 mm,0.35 mm,0.51 mm and 0.43 mm (F= -0.01,P=0.880);z: -1.16 mm, -1.20 mm, -0.88 mm and -1.03 mm (F= -0.04,P=0. 555 ), for grey registration ,x: -0.32 mm, -0.341 mm, -0.395 mm and - 0.37 mm(F=-0.01, P=0.874);y:0.34 mm,0.54 mm, -0.04 mm and 0.27 mm (F= -0.03,P=0.622);x:-1.12 mm,- 1.15 mm, - 1.13 mm and - 1.04 mm (F=0. 00,P=0. 812). Conclusions With the same registrated box and imagine quality, the location of the lesions in lung, registred methods and different doctors are not the influencing factors for CBCT imagine registration.