The fluctuation of medical staff thoughts and hospital rapid action during SARS epidemic, we name it "hospital phenomenon during SARS", has its specific characteristics. We analyzed this phenomenon from the following points: the conflict between panic response and the duty of the profession, the contradiction between the need to control infection and the available conditions, the special following phenomenon post - diagnosis of SARS and the hospital routine activity and SARS prevention and cure. We conclude that at least three fields should be improved, that is to strength education of duty morals, to normalize the medical procedure, and to build the dual system of hospital' s routine run and rapid action, in order to constructing hospital credit ethic.

Objective To discuss the predictable factors for the occurrence of intraoperative aneurysm rupture(IAR) of anterior circulation aneurysm treated by clipping.Methods The clinical data of 96 patients with 115 aneurysms treated by clipping were retrospectively analyzed.The univariate analysis and Logistic regression analysis was performed for the risk factors of IAR such as history of hypertension,pre-operative Hunt-Hess scale,aneurysm location,aneurysm sac,aneurysm dome/neck ratio,aneurysm direction,and operation time.Results Twenty-one patients occurred IAR [18.3 ％ (21/115) of aneurysms,21.9％ (21/96) of patients] during the operation,2 patients died and 94 patients were estimated by Rank scale:0 score was for 66 patients,2 scores was for 10 patients,3 scores was for 6 patients,4 scores was for 4 patients,5 scores was for 6 patients and 6 scores was for 2 patients at 6 months after surgery.Statistic analysis revealed that history of hypertension (P =0.037),pre-operative Hunt-Hess scale (P =0.040),aneurysm direction (P =0.009),aneurysm sac (P =0.010),operation time (P =0.001) and aneurysm dome/neck ratio (P =0.029) were the predictable factors for the occurrence of IAR,while aneurysm location was not included (P =0.198).Conclusion The history of hypertension,pre-operative Hunt-Hess scale,aneurysm direction,aneurysm sac,operation time and aneurysm dome/neck ratio 1.78-2.89 are the predictable factors for the occurrence of IAR and the combination of various factors lead to the occurrence of IAR.

This article analyzed the ethical situation in hospitals. The author pointed out the defect of confidence between doctor and patient is the primary cause that leaded to the deterioration of doctor-patient relation, and the retardation of medical service management is the important factor that affected the confidence construction. According to all this above, the author proposed the suggestion of strengthening the understanding and communication between doctor and patient, transforming the medical service concept, enhancing the medical service quality, completing the supervising system, increasing the hospital ability of realizing medical service defect and improving the five thoughts of follow up confidence system to direct the hospital confidence ethical construction.

Objective To introduce the preliminary experience of using rigid neuroendoscope in repair of spinal meningocele or myelomeningocele. Methods 3 infantile patients aging between 13 months and 22 months underwent the resection and repair of spinal meningocele or myelomeningocele in May, 2013. The operations were performed under the direct visualization of the rigid neuroendoscope in the aid of the intraoperative electrophysiological monitoring. All the surgical manipulations were accomplished outside the sheath of the endoscope. Results The surgical procedures were smooth. All the patients recovered satisfactorily. There was no postoperative complication. At the one-year follow-up, they were developing normally. Conclusions The rigid neuroendoscope is useful to the resection and repair of spinal meningocele and myelomeningocele. It could simplify the surgical procedures.

To investigate the patient-specific dose verification method using ArcCHECK for total marrow irradiation (TMI) with Volumetric Modulated Arc Therapy (VMAT) and Helical Tomotherapy (HT). The kVCT images collected from 8 patients were respectively designed for RapidArc and Tomotherapy plans in total marrow irradiation. ArcCHECK was used for dose verification for the head-neck, chest-abdomen and pelvic. The merging function of ArcCHECK was used in VMAT and the method of double plans (reference and delivery plans) were used in HT. The γ-analysis passing rates for the head-neck, chest-abdomen, pelvic were 98.9% ± 1.9%, 98.4% ± 1.8%, 97.4% ± 2.1% for VMAT plans and 94.3% ± 1.5%, 96.5 ± 1.2%, 94.1% ± 1.9% for HT plans. The results show that using the merging function of ArcCHECK can achieve the dose verification well for VMAT plans with TMI. The method of double plans was done for the dose verification of HT plans with TMI as well as the plans with the targets keeping away from the set-up center.
Bone Marrow ; radiation effects ; Humans ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated

Objective To investigate the feasibility of dose verification of intensity modulated (IM) planning of helical tomotherapy (HT) using two-dimensional ion chamber array (2DICA),and develop an efficient way to validate the dose delivered under the parameters mirroring those during the treatment. Meth-ods A 2DICA,I'mRT MatriXX and MULTICube equivalent solid water phantom from IBA company were used to verify the dose distribution of 10 IM planning. The combined phantom was set up to measure the dose distributions on coronal and sagittal surface. The precise setup of phantom was guided by HTMVCT images. After the irradiation, the measured dose distributions on the coronal and sngittal plane were compared with those calculated by the IM planning system for verification. The results were evaluated and the feasibility of the different measuring methods was studied. Results The dose distribution measured by the MatriXX 2DICA was well consistent with that calculated by the treatment planning system. The errors between the measured dose and predicted dose in the selected points were within ±3%. In the comparison of the pixel-segmented ionization chamber versus treatment planning system using the 3 mm/3% γ criteria, the passing ratio of pixels with γ parameter ≤1 was 97.76% and 96.83%, respectively. Conclusions MatriXX is a-ble to measure the absolute and relative dose distributions simultaneously,which can be used for dose verifi-cation of IM planning.

Objective To compare the dosimetric characteristics of helical tomotherapy(HT)and step-and-shoot intensity modulated radiotherapy(IMRT)for post-operative cervix cancer patients. Methods Ten patients with post-operative cervix cancer were enrolled in this study.HT and IMRT plans were developed for each patient.The dose distributions of the targets,organs at risk(OARs),CI and HI were analyzed and compared.The prescribed dose was 60 Gy/25 f for CTV1,50 Gy/25 f for CTV2.The iso-dose line of 50 Gy was used.Results The homogeneity indexes(HI)(0.94±0.03),conformity index(C1)(1.28±0.02)in HT group were better than in IMRT group(0.85±0.01 and 1.36±0.03),respectively(t=5.12,-6.34,P<0.001).The Dmean of PTV in HT group(51.77 Gy)was lower than that in IMRT group(54.53 Gy)(t=-8.01,P<0.05).The Dmax ,Dmean,V30,V40 and V50 of bladder、rectum and small bowel were lower in HT group than those in IM RT group.The Dmax,Dmean,V30 and V40 of right and left femoral head were lower in HT group than those in IMRT group.Conclusion Helical tomotherapy treatment plan has a better homogeneity,steeper dose gradient,and a better protection for organs at risk.

Objective To investigate the dosimetric characteristics of helical tomotherapy(HT),intensity-modulated radiation therapy(IMRT)and three.dimensional conformal radiation therapy(3D-CRT)for the post-operative breast cancer as well as their comparison in protecting the normal tissues.Methods The CT images of 10 postoperative patients with early stage breast cancer were transferRed into HT and IMRT and 3D- CRT planning system respectively after the target region and normal tissues were drawn out with the same doctor.Each prescribed dose for three kinds of plans was 50 Gy/25 fractions.Inrradiation doses and volume at heart and double lungs as well as conformity index(CI)and homogeneity index(HI)were evaluated.Results The PTV volume of prescribed target dose of 95% and 100%in HT, IMRT and 3D-CRT groups were 99.13%and 95.87%,97.80%and 94.05%,96.37%and 87.29%.respectively.The CI and HI in HT.IMRT and 3D-CRT groups were 0.80±0.10 and 1.09 ±0.03,0.65±0.07 and 1.14±0.02,0.40±0.08 and 1.17±0.04,respectively V5,V10 and V20 of the heart were the lowest at 3D-CRT than HT and lM RT.V5 of the diseased lung was the lowest at 3D-CRT compared to HT and IMRT.V5 and V10 of the healthy lung were the lowest at 3 D-CRT compared to other groups.Conclusions Compared with IMRT and 3D-CRT.HT technique in treating breast cancer had the best conformity index and homogeneity index as well as steeper dose gradient.Irradiated doses and volume at the heart was the lowest at 3D- CRT and the highest at IMRT.Irradiated doses and volume of the heart and healthy lung as well as the diseased lung were the lowest at 3D-CRT compared to HT and IMRT groups.

Objective The aim of this work is to compare the performances of EDR2 film dosimetry with two-dimensional ion chamber array (2DICA) in quality assurance (QA) procedures and to investigate the origin of possible discrepancies between the two methods.Methods A 2DICA, I′mRT MatriXX and MULTICube equivalent solid water phantom from IBA Company were used to verify the dose distribution of 15 tomotherapy plan cases.The combined phantom which includes EDR2 film on the array was set up to measure the dose distribution from coronal and sagittal orientations.After the irradiation, the dose distributions of 2DICA and film were compared with those calculated in the planning system for verification.The results and efficiency were evaluated independently in the two methods.Results The mean number of points satifying γ parameter ≤1 in the coronal and sagittal planes was 97.00%±1.56%& 95.98%±2.52%(t=-2.22,P=0.043) and 98.28%±1.55%& 95.42%±1.99%(t=0.75,P=0.464) of the 15 cases respectively for 2DICA and EDR2 film.The ratio of more than 90% and 95% were 93.3% and 66.7%.The results we presented show a very good agreement between the two methods when used to assess the dose distribution between calculated and measured doses,and a certain degree of correlation (r=0.14,P=0.001).Conclusions The 2DICA may effectively replace both film and ion chamber dosimetry in routine IMRT QA.The good agreement between 2DICA and EDR2 film may give a possible check regularly just as a gold standard.

Objective To reduce immunogenicity of porcine skin by removingα-Gal epitopes expressed in cell surface and extracellular matrix using recombinant α-galactosidase produced by Bacteroides fragilis.Methods The porcine skin was harvested from healthy 2-month-old pigs without any skin disorders before being sterilized by iodine and 75%alcohol, respectively.Enzymatic removal of α-Gal antigen was followed by washing with PBS.The α-Gal antigen in the prepared porcine skin was measured with immunofluorostaining of cryosections and the residual enzyme was measured with a double-antibody sandwich ELISA method.Enzymatic removal procedures were optimized by detecting residual enzyme and the effi-cacy ofα-Gal removal under different enzymatic and washing conditions.Results Efficient enzymatic and washing methods were established to removeα-Gal antigen.Theα-Gal removal efficacy was above 90% and residual enzyme was undetect-able (αprescribed minimum ofα-galactosidase detection with indirect ELISA was 1 ng/ml) .Conclusion It is feasible to efficiently removeα-Gal antigen under these enzymatic and washing conditions, and a method of producing low-immunoge-nicity pig skin dressing for burn is established.