Objective To investigated the absorbed dose response of Al2O3 dosimeter in water phantom irradiated by 60Co γ spectrum source. Methods The EGSnre simulation program code DOSRZnrc was used to calculate the absorbed dose of the Al2O3 dosimeter and that of the equivalent volume of water in the corresponding position, as well as the absorbed dose conversion factor, irradiated by 60Co photon beams in a water phantom. Simulations were done for a eylindrieal geometry dosimeter (diameter 0.4 cm and height 0.1 cm) and the dosimeter was placed at the centre of the water phantom at different depths. Results The average absorbed dose conversion factor is 1.143 ± 0.006 and changes little with the depth of the dosimeter in the water phantom, and the deviation is less than 1.0 %. Conclusion The absorbed dose response of Al2O3 dosimeter irradiated by 60Co γ spectrum source is steady and is independent on the depth of the dosimeter in water phantom in this research.

Objective:To evaluate the knowledge and recognition of the influence factors of adverse drug reactions in medical staffs in Nanjing.Method:A structured questionnaire was used to collect information on ADR related knowledge in medical staffs in some selected hospitals in Nanjing.Result:972 valid questionnaires were obtained form 1200 selected subjects,and the response rate was 81.0%.The scores were significantly different in age groups,sex and different kinds of occupational medical workers.The mean levels of the scores were analyzed between different groups.The single factor analysis demonstrated that the different levels of hospitals,sex,knowledge and occupation were correlated with the recognition. The multiple factors logistic regression analysis demonstrated that the recognition of adverse drug reaction among medical staff in Nanjing was related with different levels of hospitals and different occupations.Conclusion:In order to enhance the recognition level,it is necessary to carry out both the long-term education and train about the specialized knowledge of ADR in basic hospitals and non-pharmacy medical staff.

Objective To assess the effect and safety of lanthanum carbonate vs conventional phosphate binders for hyperphosphatemia in patients undergoing maintenance hemodialysis.Methods According to the collaborative search strategy,MEDLINE (1996 to 2012.12),EBCO (1996 to 2012.12),the clinical control test database of Cochrane Library and Chinese Wanfang database (1996to 2012.12) were searched.Related literature,whether Published or not and meeting summary included,were searched by hand.Quality assessment and data extraction were conducted by two independent investigators.Meta-analysis was conducted by RevMan 5.0.The following outcomes were assessed:serum phosphorus levels,serum iPTH levels,serum calcium levels and adverse events.Results were expressed as OR with 95％ confidence interval for dichotomous outcomes and WMD with 95％ confidence interval for continuous outcomes.Results A total of 10 reports were identified which met the inclusion criteria.The meta-analysis showed that the efficacy of treating hyperparathyroidism in hemodialysis patients was similar between lanthanum carbonate and conventional phosphate binders (WMD =-0.06,95％ CI-0.27 to 0.15,P =0.57) and the incidences of discontinuing due to adverse events were also similar.However,there were fewer hypercalcemic episodes and lower serum calcium levels in the lanthanum carbonate group compared to calcium-based phosphorus binders group.Conclusion Lanthanum carbonate is effective and well tolerated in treating hyperphosphatemia in hemodialysis patients with fewer hypercalcemia and lower serum calcium levels compared to calciumbased phosphate binders.

Objective To explore the feasibility and safety of emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation in the treatment of pelvic fracture combined with hemorrhagic shock.Methods A retrospective analysis of 21 patients with pelvic fractures and hemorrhagic shock who were treated with emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation was performed.The percutaneous minimally invasive screw fixation was performed immediately after embolization.Results There were 18 of 21 cases with obvious arterial bleeding confirmed by femoral artery angiography.And the corresponding interventional embolization was performed.No obvious arterial hemorrhage was found in the other 3 cases who received suspicious hemorrhagic internal iliac arterial prophylactic embolization.The time-consuming of percutaneous minimally invasive screw fixation was no more than 90 min for each patient.There was no servious complication associated with arterial embolization after intervention.Totall 18 cases were improved after discharge.Another 3 cases died,including 2 cases died for postoperative multiple organ failure or disseminated intravascular coagulation,1 case died for hemorrhagic shock caused by still continue bleeding after surgery.The postoperative follow-up was performed during 3-18 months with the average of (10.81 ± 2.62) months.The fractures in all the surviving cases achieved bone healing with good function.Conclusion The emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation is a safe,fast and effective method for the treatment of pelvic fractures and hemorrhagic shock with less complications.

Objective To investigate the relationship between 24-hour urinary protein quantification and maternal and neonatal complications in severe preeclampsia. Methods Totally 2305 cases of pregnant women which were diagnosed as severe preeclampsia more than 28 weeks of single pregnancy in 37 hospitals in mainland China were selected from January 1 to December 31, 2011. According to the results of the highest 24 hours urine protein quantitative after admission, the subjects were divided into 3 groups. The group Ⅰ included 590 cases whose 24h urinary protein were 0-2g. There were 843 cases in group Ⅱ whose 24h urinary protein were 2-5g, 872 cases were in group Ⅲ whose 24h urinary protein were more than 5g. The complications of the maternal and neonatal outcome were analyzed among the three groups. Results The incidence of hypoalbuminemia was 14. 8％, the rate of chest /ascites /pulmonary edema / heart failure was 1. 6％, the incidence of renal dysfuction was 0. 6％ and the incidence of placental abruption and HELLP syndrome was 2. 7％ and 3. 0％. There was significant difference in the incidence of hypoalbuminemia among the three groups of which the incidence of groupⅠwas significantly lower than that of group Ⅱ and group Ⅲ (P ＜ 0. 017). The rate of fetal growth restriction, fetal distress and neonatal asphyxia was 3. 3％, 9. 5％, and 1. 1％. The incidence of neonatal body weight, fetal growth restriction and neonatal asphyxia among the three groups were significantly different (P ＜ 0. 05). The body weight of neonatal group was significantly higher than that of group Ⅱ and group Ⅲ (P ＜ 0. 017). The incidence of FGR in group Ⅱ was significantly higher than that in group Ⅲ (P ＜ 0. 017). The rate of neonatal asphyxia in group Ⅰ was significantly lower than that in group Ⅲ (P ＜ 0. 017). There are no significant difference in the incidence of heart failure /pulmonary edema, placental abruption, HELLP syndrome and cesarean section among the three groups. Conclusion 24-hour urinary protein may increase the risk of hypoalbuminemia in pregnant women with severe preeclampsia, but do not increase the risk of heart failure /pulmonary edema, placental abruption and HELLP syndrome. 24-hour urinary protein was associated with severe preeclampsia neonatal body weight, fetal growth restriction, and neonatal asphyxia.

Objective Based on the medical records and follow-up records of hospitalized patients who received anti-tuberculosis therapy in the Third People' s Hospital of Zhenjiang in Jiangsu province from 2006 to 2012,we investigated the incidence and outcome of anti-tuberculosis drug induced hepatotoxicity (ATDH) and provided evidence for the prevention of ATDH.Methods According to tuberculosis patients' medical information and liver function test records,ATDH patients were diagnosed according to the criteria of International Consensus Meeting and American Thoracic Society respectively,then the related factors and outcomes were analyzed.Results A total of 1 967 hospitalized tuberculosis patients were reviewed retrospectively,in which 1 403 (71.3％) were men,1 790 (91.0％) were pulmonary tuberculosis patients,1 528 (77.8％) were patients receiving initiative treatment,979 (49.8％) were sputum smear-positive patients,and 1 297 (65.9％) had other complicated diseases.According to the criterion of International Consensus Meeting,the incidence of ATDH was 16.5％,the median time of onset was 25 days.According to the criterion of American Thoracic Society,the incidence of ATDH was 8.3％,the median time of onset was 23 days.The incidence of ATDH was significantly higher in males and HRZE therapy group (P＜0.05).Under the two liver criteria,69.5％ and 70.1％ of the patients changed primary therapy respectively after ATDH occurred.89.8％ and 88.4％ patients' liver function returned to normal range after changing or stopping therapy.Conclusion According to two liver injury criteria,the incidences of ATDH were 16.5％ and 8.3％ in hospitalized tuberculosis patients respectively,and ATDH mainly occurred in the furst month of anti-tuberculosis treatment.The monitoring of liver function should be strengthened in males and HRZE therapy group to reduce the incidence of ATDH.

Objective: To conduct a preliminary evaluation for the usability of Carelink remote monitoring system by clinical physician. Methods: A total of 215 patients received cardiovascular implantable electronic devices (CIED) with Carelink remote monitoring function from 12 hospitals in China between 2012-01 and 2013-10 were prospectively enrolled. The patient's mean age was (62.3±14.3) years including 108 male and 107 female. There were 54 physicians completed questionnaire survey. Based on the type of CIED, the patients were divided into3 groups: PM (pace maker) group,n=110, ICD (implantable cardioverter defibrillator) group,n=54 and CRT (cardiac resynchronization therapy) group,n=51. The patients received routine hospital visit at 3 months of CIED implantation and meanwhile, they performed device data transmission at 3 and 6 months of Carelink remote monitoring. The time physician spent to evaluate data was collected at 3 months and the questionnaire survey was completed by physician at 6 months after CIED implantation. Results: All 54 physicians felt that Carelink remote monitoring system was simple to operate and easy to use. There were 147 patients ifnished hospital visit at 3 months after CIED implantation, the mean time for physician to evaluate data was (14.8±8.4) min; 150 patients ifnished Carelink remote monitor at 3 months after CIED implantation, the mean time for physician to evaluate data was (8.2 ±4.6) min,P<0.0001.Conclusion: Carelink remote monitoring system was easy to use, it may save time in follow-up study which with high satisfaction in clinical practice.

OBJECTIVETo study the efficacy and safety of thoracoscopic and laparoscopic esophagectomy for esophageal carcinoma.

METHODSBased on hospitalization data from March 2011 to March 2014, 62 cases of esophageal carcinoma treated with thoracoscopic and laparoscopic esophagectomy (minimally invasive group, with 45 male patients) and other 62 cases treated with open esophagectomy (open esophagectomy group, with 45 male patients) were analyzed in a retrospective cohort. The mean age of two groups were (62±9) years and (62±8) years, respectively. Quantitative data were analyzed using t-test, whereas qualitative variables were tested with χ2 test. There were no significant difference in age, tumor location, pathological type, tumor staging between two groups (P>0.05). Perioperative data and three-year clinic outcome were collected. The three-year survival curve were calculated with the Kaplan-Meier method and compared by the log-rank test between the two groups.

RESULTSCompared with open esophagectomy group, minimally invasive group has less amount of bleeding during operations ((231±40) ml vs. (302±37) ml, t=4.63, P=0.000), pleural drainage after operations ((490±41) ml vs. (1 090±43) ml, t=-79.59, P=0.000), and postoperative hospital stay ((16±4) days vs. (17±4) days, t=-2.61, P=0.010). Meanwhile, minimally invasive group has more operation time ((272±39) minutes vs. (242±45) minutes, t=3.97, P=0.000) and total and thoracic cavity retrieved lymph nodes (30±5 vs. 28±4, t=2.39, P=0.018; 15±4 vs. 14±3, t=2.59, P=0.011). Nineteen and 31 patients had postoperative complications and statistical significance difference was found between two groups (χ2=4.83, P=0.028). The three-year survival rate was 73.2% in minimally invasive group and 71.4% in open esophagectomy group. There was no significance difference between two groups (χ2=0.170, P>0.05).

CONCLUSIONThoracoscopic and laparoscopic esophagectomy had the advantages of amount of bleeding, postoperative hospital stay and complications, and had the same three-year survival rate with open esophagectomy.

Aged ; Carcinoma ; surgery ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Staging ; Operative Time ; Postoperative Complications ; Retrospective Studies

Objective:To observe heart rate circadian rhythm in patients with chronic kidney disease (CKD) stage 5 and to analyze the effects of parathyroidectomy (PTX) on heart rate circadian rhythm in severe secondary hyperparathyroidism (SHPT) patients.Methods:A cross-sectional observation was performed in 213 patients with CKD stage 5 and 96 controls, and the patients were divided into those with severe SHPT (PTX group, n=70) and without severe SHPT (non-PTX group, n=143). Forty-six PTX patients were followed up prospectively. The baseline data were compared among these groups. Holter electrocardiogram was performed for each participant. Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9. Multiple linear regression analysis was used to analyze the related factors of heart rate circadian rhythm in patients with CKD stage 5. Results:The 24-hour, daytime and nighttime mean heart rate in patients with CKD stage 5 were all higher than those in controls, especially in PTX group (all P<0.05). The night/day heart rate ratios of controls and CKD stage 5 patients were (0.81±0.08) and (0.91±0.08) respectively ( P<0.01). Correlation analysis showed 24-hour and daytime or nighttime mean heart rate in patients with CKD stage 5 were positively correlated with serum levels of phosphorus and ln(alkaline phosphatase), while nighttime mean heart rate and night/day heart rate ratio were positively related with serum intact parathyroid hormone level. After adjusting with postoperative follow-up period (median time: 10.9 months), 24-hour and nighttime mean heart rate, and night/day heart rate ratio in PTX patients all decreased significantly (all P<0.01). Conclusions:Heart rate is increased and circadian rhythm is abnormal in patients with CKD stage 5, which are related with mineral and bone disorder. PTX significantly decreases 24-hour and nighttime mean heart rate in severe SHPT patients, and improves the heart rate circadian rhythm.

Objective To make the cost-effectiveness analysis of pembrolizumab and platinum chemotherapy as the first-line treatment for advanced non-small cell lung cancer （NSCLC） in the population with tumor proportion score （TPS） ≥ 1% of PD-L1, and provide some reference for the clinical use and future price negotiation of pembrolizumab. Methods Based on Pubmed database, the published RCT literatures of pembrolizumab were analyzed, and the survival data were extracted, combined with the treatment plan of a tertiary hospital, the Markov model were established to simulate the cost and health effectiveness of patients for twenty years, and the stability of the model was tested by one-way sensitivity analysis and probability sensitivity analysis. Results Twenty years later, the cost-effectiveness ratio of pembrolizumab group and chemotherapy group was ￥58 517.60/quality adjusted life month (QALM) and ￥41 213.08/QALM. Compared with the chemotherapy group, the incremental cost effective ratio (ICER) was ￥104 485.36/QALM. Conclusion When the willingness to pay （WTP） value was ￥30 902/QALM, the pembrolizumab therapy was not more cost-effective advantages than platinum chemotherapy, and the sensitivity analysis showed that the results of the model were relatively stable.