Objective To analyze the volumetric and dosimetric variations in radiation treatment planning(RTP) using CT images based on normal and extended reconstructed field-of-view(FOV). Methods Original data of CT scans from 16 cases of nasopharyngeal carcinomas were reconstructed to form 2 sets of CT images with Dermal(45 cm)and EFOV(65 cm),which were then exposed to RTP. Contouring of targets/OAR including GTV(gross tumor volume),CTV(clinical target volume,CTV),brain stem, lens, parotids and cord was made on normsl FOV CT set.A 7-field equi-angular IMRT (intensity modulated radiation Therapy)plan was generated with prescribed GTV dose of 70 Gy.Two sets 0f CT images were fused in DICOM coordinate system and targets/OARs on normal FOV CT were copied to EFOV CT.IMRT plans were then transplanted from normal FOV to EFOV CT,with the same isocenter on DICOM coordinates.Volumetric and dosimetrie variations including GTV,CTV brain stem,lens, parotids and cord were calculated on dose-volume-histogram(DVH).For dosimetric verification,IMRT plans were input into fluence maps of Mapcheck 1175 phantom based on normal FOV and EFOV, and DTA(distance to agreement)was used to analyze the passing rate of calculated/measured absolute doses at 5 cm depth.Paired-t test was used to compare the passing rate of field 1-7 of IMRT plans based on 2 CT sets.Results Volumes of targets and OARs on 2 CT sets of different FOVs were statistically different.with larger calculated volume on norlual FOV in all cases.There was no statistic difference in the maximal(Dmax) doses received by all targets and OARs except the small-volume lens, in which the dose was higher on normal CT than that on EFOV CT(t=-3.14,P<0.007).The mean doses(Dmean)to the CTV(clinical target volume)and GTV(gross tumor volume)were higher on EFOV than normal FOV CT(t=-6.45,-5.65,P<0.001).There was no statistic difference in Dmean received by OARs and the minimal dose (Dmin)by all targets and OARs(P>0.05).There was also no statistic difference in the passing rate of field 1-7 of IMRT plans based on 2 CT sets.Conclusions There were volumetric and dosimetric variations as evaluated on DVH using different reconstructed FOV during CT simulation,though the difference between the passing rates as verified in 2 dimensional fluence map was not significant.

Objective To study the preventive effect of Omeprazole on post-endoscopic retrograde choledo-chopallcreatography(ERCP)-induced pancreatitis.Methods 126 patients were divided into two groups at random.One group received Omeprazole 20mg bid for two days.and the other group received placebo(Vitamine B).Blood was drawn in each group the day before,4 hours and 24 hours following ERCP for examination of amylase and hepa-torenal functions.Meanwhile Meanwhile the clinical manifestations of acute pancreatitis were also observed.Results Acute pancreatitis was clinically induced in 1.59% cases of placebo group,but none in the Omeprazole group.Hyperamy-lasemia occurred in 20.63%-7.93%in Omeprazole group at 4 hours and 24 hours after ERCP operation,while 30.16%.14.29%in placebo group;The incidence rate of acute pancreatitis following ERCP and hyperamylasemia 4 h after ERCP in omeprazole group were significantly lower than in placebo group(P<0.01,P<0.05).There were no significance differences in amylase 24 hours following ERCP between two groups(P>0.05).Concluslon Omeprazole can prevent the acute pancreatitis induced by ERCP to some extent.

BACKGROUND:The biomechanical properties of naturaly regenerated damaged articular cartilage that belongs to the fibrovascular tissue are far worse than those of the normal cartilage so that they cannot meet the requirements for joint function, leading to traumatic arthritis and loss of joint function.
OBJECTIVE:To evaluate the effects of matrix metaloproteinase-3 (MMP-3) inhibitor I with different concentrations on the early-stage repair of ful-thickness articular cartilage defects in the knee of rats.
METHODS: Twenty-four Sprague Dawley rats were randomized into control, defect (DEF), and defect combined with low-(D+L) and high-dose inhibitor (D+H) groups (n=6 for each group), respectively. Full-thickness articular cartilage defects followed by intraarticular injection of low- and high-dose MMP-3 inhibitor I for 4 weeks was administered in the later two groups. Serum MMP-3 was detected using ELISA method before and after experiment, respectively. Femoral trochleas were collected to observe characteristics of repaired tissue by gross appearance scoring and O’Driscoll histological scoring with Safranine O-Fast Green staining, and to measure type II colagen by immunohistochemistry after experiment.
RESULTS AND CONCLUSION:Rats in the D+H group had obvious repair similarly to hyaline articular cartilage, while creamy white cartilage tissue and fibrous tissue repair were observed in D+L group and in DEF group. D+H group obtained the best repair results according to gross appearance scoring and O’Driscol histological scoring and the highest content of type II colagen (P< 0.05). MMP-3 concentration and the difference value before and after experiment were gradualy decreased in DEF, D+L, D+H, and control groups in sequence(P< 0.05). These findings demonstrate that MMP-3 inhibitor I accelerates the early-stage repair of ful-thickness articular cartilage defects in the knee of rats.

Objective To investigate the incidence and risk factors of surgical site infection ( SSI ) in patients with colorectal cancer .Methods Clinical data of patients with colorectal cancer undergoing surgical treatment in Jiaxing First Municipal People’ s Hospital from October 2011 to December 2014 were retrospectively reviewed.The gender, age, underlying diseases, smoking history, preventive medication, abdominal surgery history , type of surgery , preoperative levels of hemoglobin and albumin , use of laparoscopy, use of stapler, combined organ resection, TNM staging, American Society of Anesthesiologists ( ASA) score was documented .Multivariate logistic regression analysis was performed to identify the risk factors of SSI .Results A total of 773 patients were enrolled in the study , and SSI was observed in 144 cases (18.63%).Multivariate logistic regression analysis showed that use of laparoscopy ( OR =0.35, 95%CI:0.15-0.79,P <0.05), use of stapler (OR =0.59, 95% CI: 0.39-0.88,P <0.05) were protective factors for SSI, while diabetes (OR=2.11, 95% CI: 1.25-3.58,P<0.01), liver cirrhosis (OR=2.12,95%CI:1.18-3.79,P<0.05), ASA score (3-4 points) (OR=2.01,95%CI:1.20-3.58, P<0.01), combined organ resection (OR=2.17,95% CI:1.20-3.92,P<0.05), and anastomotic leak (OR=6.85, 95%CI:3.01-15.63,P<0.01) were risk factors for SSI.Conclusions The incidence of SSI is high in patients with colorectal cancer undergoing surgery .Use of laparoscopy and stapler may reduce the incidence of SSI .

OBJECTIVE To reduce incidence of infection caused by Pseudomonas aeruginosa(PAE) in orthopedic operation site. METHODS Efforts on quality managements were enhanced in each step,including strict check of implanted devices for orthopedic procedure and reliable preparation of skin area before operation,standardized operation techniques and incision protection skill during operation as well as wound care and ward environment managements after surgery. RESULTS With enhanced efforts taken in each step of quality managements,the incidents of PAE infection of orthopedic operation site have fallen significantly from 1.27% down to 0.11%(P

Objective To expand the influence and promotion effect of the grassroots health demonstration base of appropriate technology at county level,explore the practice model for full coverage.Methods Four consortium and eight units in the county were engaged into the whole process,the whole cycle,synchronous implementation;the promotion practices were divided into different stages with different focuses based on priority setting;Stratified training,classified promotion strategies were involved to carry out the appropriate technology for all 11 items covered.Results The technical promotion training,technical promotion applications were completed with full coverage in the county,gained high satisfaction from both medical staff and public.Enhanced the technology radiation ability,also the base's annual development was increasing year by year.Conclusions The base construction full coverage promotion experiences can be shared and learned by other areas which aims for the promotion of fit health techniques.

Objective To compare the effect of three fixed methods in patients with lumbar catheters continuous drainage.Methods One hundred and twenty patients with lumbar catheters continuous drainage were chosen and divided into three groups according to the random number table, each with 40 cases.Three groups received the shoulder fixation, lumbar fixation and modified lumbar fixation, respectively.The incidence of complication after catheter, the skin injury in the fixed position and the patients’ satisfaction were compared in three groups.Results The cases of patients with pipe slip were respectively 5,4,0 in three groups, and the cases of patients with poor drainage were respectively 7,6,1, and the cases of patients with puncture point infection were respectively 8,8,2, and the cases of patients with cerebrospinal fluid leak were respectively 5,6, 0, the cases of patients with intracranial infection were respectively 7,9,1, and the differences were statistically significant in three groups (χ2 =5.05,5.01,4.71,6.21,7.13, respectively;P <0.05).The number of changing dressings were respectively (10 ±1.78),(10 ±2.28),(3 ±1.13) in three groups, and the difference was statistically significant (F=23.54,P<0.05).The cases of patients with pressure ulcers were respectively 7,5, 0 in three groups, and the cases of patients with satisfaction were respectively 20, 24, 33, and the differences were statistically significant in three groups (χ2 =7.20,9.64, respectively;P <0.05). Conclusions Application of the modified lumbar fixation can reduce the incidence of complication of lumbar catheters continuous drainage, and reduce the skin injury, and increase the patients’ satisfaction, and is worthy of clinical promotion.

Objective To observe the immunological mechanism of glycyrrhizic acid ointment on chronic eczema mouse model. Methods Mice were randomly divided into blank control group,model control group,base material group, dexamethasone acetate cream group,glycyrrhizic acid ointment high,medium and low dose groups.Except for the blank control group,chronic eczema mouse model was established by chronic repeated 2,4-nitrochlorobenzene stimulation.The contents of IL-4, IL-18,IFN-γ in serum and the T lymphocyte subpopulation in the peripheral blood were all determined after 14 days. Results Glycyrrhizic acid ointment in high,medium groups could significantly reduce the contents of interleukin (IL)-2,IL-5,IL-6,IL-18,interferon(IFN)-γ in serum,with significant differences as compared with the model control group(P<0.01 or P<0.05).The content of IL-4 in serum was significantly increased in the glycyrrhizic acid ointment high,medium groups as compared with the model control group (P<0.01 or P<0.05).Compared with model control group,CD+4T lymphocyte percentage and CD+4/CD+8T in peripheral blood were significantly increased,and CD+8T lymphocyte percentage decreased significantly (P<0.01 or P<0.05). Conclusion Glycyrrhizic acid ointment's effect of treating chronic eczema may be related to regulating the balance of Th1 and Th2 and correcting the immune disorders.

Objective:To explore the effect of failure mode and effect analysis (FMEA) in the management of nosocomial infection, and provide reference for the effective prevention and control of nosocomial infection.Methods:Using FMEA to identify, analyze, evaluate and screen out the high-risk events of nosocomial infection in January 2020, from which two hospital level priority improvement projects of hand hygiene compliance and blood-borne occupational exposure were determined. After risk control and intervention measures, the effects before and after improvement were compared.Results:Except for the lack of incentive mechanism and insufficient communication between medical and nursing teams, the differences in hand hygiene compliance and blood-borne occupational exposure risk priority coefficients before and after the implementation of FMEA were statistically significant ( P<0.05) . After the implementation of FMEA, the hand hygiene compliance was 74.92% (79375/105953) , which was significantly higher than 68.40% (58361/85328) before the implementation of FMEA, and the difference was statistically significant (χ 2=996.55, P<0.01) . The incidence of blood-borne occupational exposure after the implementation of FMEA was 3.85% (80/2080) , which was lower than the 6.16% (123/1998) before the implementation of FMEA, and the difference was statistically significant (χ 2=11.49, P<0.01) . Conclusion:FMEA has a good effect in nosocomial infection management. It can identify and evaluate the risk of nosocomial infection prospectively, so as to control the risk effectively.

Objective:To explore the effect of failure mode and effect analysis (FMEA) in the management of nosocomial infection, and provide reference for the effective prevention and control of nosocomial infection.Methods:Using FMEA to identify, analyze, evaluate and screen out the high-risk events of nosocomial infection in January 2020, from which two hospital level priority improvement projects of hand hygiene compliance and blood-borne occupational exposure were determined. After risk control and intervention measures, the effects before and after improvement were compared.Results:Except for the lack of incentive mechanism and insufficient communication between medical and nursing teams, the differences in hand hygiene compliance and blood-borne occupational exposure risk priority coefficients before and after the implementation of FMEA were statistically significant ( P<0.05) . After the implementation of FMEA, the hand hygiene compliance was 74.92% (79375/105953) , which was significantly higher than 68.40% (58361/85328) before the implementation of FMEA, and the difference was statistically significant (χ 2=996.55, P<0.01) . The incidence of blood-borne occupational exposure after the implementation of FMEA was 3.85% (80/2080) , which was lower than the 6.16% (123/1998) before the implementation of FMEA, and the difference was statistically significant (χ 2=11.49, P<0.01) . Conclusion:FMEA has a good effect in nosocomial infection management. It can identify and evaluate the risk of nosocomial infection prospectively, so as to control the risk effectively.